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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would only prolong the dying process be withheld or withdrawn, and that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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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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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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Anatomical Gifts
You will
be given the option to donate organs and/or tissues for
transplantation once you have been declared dead. If you elect to
donate organs and/or tissues for transplantation, you may be maintained on
artificial support systems only for the period of time required to
maintain the viability of and to remove such organs and/or tissues.
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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 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
You must gather two witnesses and appear before a notary public for
signing. Pay particular attention to the qualifications of the
witnesses expressed in the witness statement. After signing, 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. You should also
give a copy to trusted family members.
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SOURCE: Tennessee Code §32-11-105; Form of Declaration |
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