Durable Power Of Attorney For Healthcare Decisions (Page 3 of 8) in pdf

In exercising the authority under this Durable Power of Attorney for healthcare, the

authority of my attorney-in-fact is subject to the following special provisions and

limitations:

________________________________________________________________________

5. DURATION

I understand that this Power of Attorney will exist indefinitely from the date I execute

this document unless I establish a shorter time. If I am unable to make health care

decisions for myself when this Power of Attorney expires, the authority I have granted

my attorney-in-fact will continue to exist until the time when I become able to make

health care decisions for myself.

(IF APPLICABLE)

I wish to have this Power of Attorney end on the following date: ___________________

6. STATEMENT OF DESIRES

(With respect to decisions to withhold or withdraw life-sustaining treatment, your

attorney-in-fact must make health care decisions that are consistent with your known

desires. You can, but are not required to, indicate your desires below. If your desires are

unknown, your attorney-in-fact has the duty to act in your best interests; and, under some

circumstances, a judicial proceeding may be necessary so that a court can determine the

health care decisions that is in your best interest. If you wish to indicate your desires,

you may INITIAL the statement or statements that reflect your desires and/or write your

own statements in the space below.)

1. I desire that my life be prolonged to the greatest extent possible, without

regard to my condition, the chances I have for recovery or long-term

survival, or the cost of the procedures.

__________

If I am in a coma which my doctors have reasonable concluded is irreversible,

I desire that life sustaining or prolonging treatments not be used. (Also should

utilize provisions of NRS 449.535 to 449.690, inclusive, if this subparagraph

is initialed).

__________

If I have an incurable or terminal condition or illness and no reasonable hope

of long-term recovery or survival, I desire that life-sustaining or prolonging

treatments not be used. (Also should utilize provisions of NRS 449.535

to 449.690, inclusive, and sections 2 to 12, inclusive, if this subparagraph

is initialed).

_________

4. Withholding or withdrawal of artificial nutrition and hydration may result

in death by starvation or dehydration. I want to receive or continue receiving

artificial nutrition and hydration by way of the gastro-intestinal tract after all

other treatment is withheld

__________

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