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Election of Treatment(s)
After you have completed this directive and
printed it out, you will be allowed to check off treatments you want and
don't want. You will be given the option of receiving
artificial nutrition and hydration and other treatment.
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Designation of Agent
This living will (Declaration of a Desire for Natural Death) gives you the
option to designate an
agent and alternate agent to revoke this declaration on your behalf or enforce this
declaration on your behalf.
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Duty of Attending
Physician(s)
When your declaration
becomes operative your attending physician and other health care providers
shall act in accordance with its provisions. An attending physician
or health care provider who is unwilling to comply with the Rights of the
Terminally Ill Act shall take all reasonable steps as promptly as
practicable to transfer your care to another physician or health care
provider who is willing to do so. A physician or other health care
provider who willfully fails to transfer your care is subject to criminal
penalties.
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Ancillary
Effect of Living Will
Death
resulting from the withholding or withdrawal of life-sustaining treatment shall not
constitute, for any purpose, a suicide or homicide. The making of a declaration shall not affect
the sale, procurement, or issuance of a policy of life insurance or
annuity or affect, impair, or modify the terms of an existing policy of
life insurance or annuity. A policy of life insurance or annuity
shall not be legally impaired or invalidated by the withholding or
withdrawal of life-sustaining treatment from an insured, notwithstanding
any term to the contrary.
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Revocation
Your declaration may be revoked at any time
in any manner by which you are able to communicate your intent to revoke,
without regard to your mental or physical condition. Your attending
physician shall make your revocation a part of your medical records.
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 Executing and Delivering Your Living Will
After you have completed your living will, you must gather two witnesses
and appear before a notary public for signing. Pay particular
attention to the qualifications of the witnesses as stated in the
affidavit of the witnesses. You should provide a copy of your completed
living will to your attending physician and other health care providers
and they shall make it a part of your medical records. |
If at any time you have a condition
certified to be a terminal condition by two physicians who have personally
examined you, one of whom is your attending physician, and the physicians
have determined that your death could occur within a reasonably short
period of time without the use of life-sustaining procedures or if the
physicians certify that you are in a state of permanent unconsciousness
and where the application of life-sustaining procedures would serve only
to prolong the dying process, you may direct that the procedures be
withheld or withdrawn, and that you be permitted to die naturally with
only the administration of medication or the performance of any medical
procedure necessary to provide you with comfort care. 