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CONDITIONS
UNDER WHICH YOU MAY EXECUTE A LIVING WILL
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 If you have a
terminal
condition you may elect that your life not be prolonged and that you do
not want any life sustaining treatment, beyond comfort care, that would
serve only to artificially delay the moment of your death.
If you have a
terminal
condition or an irreversible coma or otherwise in a
persistent vegetative
state that your doctors reasonably feel to be irreversible or incurable,
you may refuse artificially provided nutrition and hydration.
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ADDITIONAL INFORMATION ABOUT THIS LIVING WILL |
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Election of Treatment(s)
After you have completed this form and printed it out, you will be
allowed you to check off treatments you want and don't want.
Among those are matters which relate to treatment while you are
permanently unconscious and the condition is irreversible. You
will be given the option of receiving artificial nutrition and
hydration and other 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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Pregnancy
Notwithstanding other
directions, if you are pregnant, you can elect that life-sustaining
treatment not be withdrawn if it is possible that the embryo/fetus will
develop to the point of live birth with the continued application of
life-sustaining treatment.
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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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 Executing and Delivering Your Living Will
After you have printed
out your document, you will have to gather two witnesses for signing. You should provide
the original of your completed
living will to your attending physician with copies to other health care providers
and they shall make it a part of your medical records. You should also
give a copy to your family. If you revoke your living will, you should
submit the original to your physician as well.
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