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Adding Additional Directives
This living will allows you to
incorporate by reference other written statements of your desires.
If you talk to your physicians and family members and feel you must
add other directives, do so in your own handwriting and attach to this
form.
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Operative Date
Your living will becomes operative when a copy is provided to
your attending physician; and you are determined by
your attending physician to be incompetent and in a terminal condition or
in a state of permanent unconsciousness.
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Duty of Attending
Physician(s)
When your living will becomes
operative, your physician and other health care providers shall act in
accordance with its provisions. If your attending physician or other
health care provider cannot in good conscience comply with the provisions
of your living will or if the policies of the health care provider
preclude compliance, your attending physician or health care provider
shall so inform you, or, if you are incompetent, shall so inform your
agent, or, if you have not designated a health care proxy, shall so inform
your family, guardian or other representative. Your physician and
health care provider shall make every reasonable effort to assist in the
your transfer to another physician or health care provider who will comply
with your living will.
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Appointment of
Health Care Agent
In the event you are
unable to provide express and informed consent regarding the
withholding, withdrawal or continuation of life-prolonging procedures,
you may designate an agent to do so. However, this living will does
not provide for the appointment of an agent to make general decisions
regarding your health. If you want to empower your agent with
additional authority to make your health care decisions, you must use
a Health Care Proxy. It is advisable
to have both a Living Will and Health Care Proxy so that you have
complete control over who is making health care decisions on your
behalf.
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Pregnancy
Notwithstanding other
directions, if you are pregnant, you can elect that life-sustaining
treatment not be withdrawn if it is possible that the embryo/fetus will
develop to the point of live birth with the continued application of
life-sustaining treatment.
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Revocation
Your living will may be
revoked at any time and in any manner by you without regard to your
mental or physical condition. A revocation is effective upon
communication to your attending physician or other health care
provider by you or a witness to the revocation. Your attending
physician or other health care provider shall make your revocation a
part of your medical records.
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Ancillary Effect of
Executing Living Will
Death resulting from the withholding or withdrawal of life-sustaining
treatment does not constitute, for any purpose, a suicide or homicide.
The making of a declaration does not affect in any manner the sale,
procurement, or issuance of any policy of life insurance, nor does it
modify the terms of an existing policy of life insurance. A policy
of life insurance is not legally impaired or invalidated in any manner by
the withholding or withdrawal of life sustaining procedures from an
insured qualified patient, notwithstanding any term of the policy to the contrary.
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 Executing and Delivering Your Living Will
After you have printed out your declaration you must gather two
witnesses over eighteen (18) for signing. None of the witnesses should
be a beneficiary under your last will and testament or otherwise
interested in your estate. The executed original or copy of
original should be submitted to your physician for entry in your medical
records. Copies should be made and given to trusted family members.
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If you have a
terminal
condition you may elect that your life not be prolonged and that you do
not want any life sustaining treatment, beyond comfort care, that would
serve only to artificially delay the moment of your death.
