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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would only prolong the dying process be withheld or withdrawn, and that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.
"Life-prolonging procedure" means
a) any
medical procedure, treatment or intervention which utilizes mechanical or
other artificial means to sustain, restore or supplant a spontaneous vital
function, or is otherwise of such a nature as to afford a patient no
reasonable expectation of recovery from a terminal condition; and b) when
applied to a patient in a terminal condition, would serve only to prolong
the dying process. The term includes artificially administered
hydration and nutrition.
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ADDITIONAL INFORMATION ABOUT THIS LIVING WILL |
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Special Instructions
You may write in any
special instructions you desire regarding your treatment.
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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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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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Revocation
A declaration may be
revoked at any time and in any manner by which you are able to communicate
an intent to revoke, without regard to mental or physical condition.
A revocation is only effective as to the attending physician or any health
care provider upon communication to that physician or health care provider
by you or by another who witnesses your revocation.
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Ancillary Effect of
Executing Living Will
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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Exe cuting
and Delivering Your Living Will
After you have printed
out
your document, you must sign in front of two witnesses over the age of 18.
None of the witnesses may be a blood relative. A fully executed original or copy should be made and
given to your physician. If you revoke your living will you should provide
a fully executed copy of your revocation to your physician for
placement in your medical records as well. You should also
provide trusted family members with copies of your living will and any
subsequent revocation.
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