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CONDITIONS
UNDER WHICH YOU MAY EXECUTE A LIVING WILL
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 If you should be in a
terminal condition
that will result either in death within a relatively short period of time
or be in a permanent unconsciousness state
from which, to a reasonable degree of medical certainty, there can be no
recovery, you may express your desire that your life not be prolonged by
the administration of life-sustaining procedures.
"Permanent unconscious state"
means your state of permanent unconsciousness, to a reasonable degree of medical
certainty as determined in accordance with reasonable medical standards by your
attending physician and one other physician who has examined you, is
characterized by both of the following: 1) Irreversible unawareness of your
being and environment; and 2) Total loss of cerebral cortical functioning,
resulting in your having no capacity to experience pain or suffering.
"Terminal condition" means an
irreversible, incurable, and untreatable condition caused by disease, illness.
or injury from which. to a reasonable degree of medical certainty as determined
in accordance with reasonable medical standards by your attending physician and
one other physician who has examined you, both of the following apply: 1) There
can be no recovery; and 2) Death is likely to occur within a relatively short
time if life-sustaining treatment is not administered.
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ADDITIONAL INFORMATION ABOUT THIS LIVING WILL |
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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 an agent is not named in your living will, 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
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
authority to make your health care decisions, you must use a
Power of Attorney for Health Care.
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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Revocation
You may revoke your declaration at any time
and in any manner. The revocation shall be effective when you
express your intention to revoke the declaration, except that, if you have
made your attending physician aware of the declaration, the revocation
shall be effective upon its communication to the your attending physician
by yourself, a witness to the revocation, or other health care personnel
to whom the revocation
is communicated by such a witness.
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Executing and Delivering Your Living Will
After you have completed your directive you should sign it before a
notary public OR in front of two witnesses. If you sign in front of two
witnesses pay particular attention to the qualifications contained in
the witness statement. You should provide a copy of your completed
advance directive to your attending physician and other health care providers
and they shall make it a part of your medical records. You should also
give a copy to trusted family members.
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