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CONDITIONS
UNDER WHICH YOU MAY EXECUTE A LIVING WILL
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 If at any time you should have
an incurable condition certified in
writing by your attending physician and one other qualified physician to be terminal or you have been unconscious, comatose, or otherwise incompetent so as to
be unable to make or communicate responsible decisions concerning your
person, you may direct that such procedures which
would only prolong the dying process be withheld or withdrawn, and that
you be permitted to die naturally with only the administration of
medication to provide you comfort care.
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ADDITIONAL INFORMATION ABOUT THIS LIVING WILL |
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Designation of Agent
You may designate an
agent and alternate agent to make medical decisions on your behalf should
you become incompetent and in a terminal condition or in a state of
permanent unconsciousness.
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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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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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 Executing and Delivering Your Living Will
After you have printed
out your declaration you must gather two witnesses for signing. 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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