Protective Durable Power Of Attorney For Health Care (Page 6 of 8) in pdf

Protective Durable Power Of Attorney For Health Care Page 6

DIRECTIONS AND LIMITATIONS

I have discussed my beliefs, principles, and health care preferences with my agent. I trust my

agent to make health care decisions for me based on my desires as stated in this document or

which I have otherwise expressed to my agent.

1. I have discussed the meaning of the words used in this document with my agent and my

agent’s interpretation of them is controlling. “Benefit” refers to my physical health,

comfort, and longevity and shall not be determined by quality of life judgments. I

direct that nothing in this document be interpreted to request or authorize

providing, withholding, or withdrawing treatment or care for the purpose of

causing my death.

2. My agent has the authority to request, review, and receive any information, oral or

written, regarding my physical or mental health, including medical and hospital records,

and to consent to the disclosure of this information.

3. I direct that nutrition and hydration, administered either orally or by artificial means, be

provided to me unless I am unable to assimilate food and fluids, their administration

causes serious complications, or my death is inevitable within days or hours from a

cause independent of nutrition and hydration.

4. I direct my agent to request, require, and consent to care, treatment, and procedures

which are appropriate to my condition/offer hope of benefit.

5. I direct my agent to refuse care, treatment, and procedures which are not appropriate to

my condition/do not offer hope of benefit.

6. I direct that my agent, not a health care provider, determine whether or not a Do Not

Resuscitate (DNR) order is appropriate for me.

7. I authorize my agent to admit me to or discharge me from a long-term care facility or

other residential or community-based care facility.

8. If I am pregnant, I direct that every effort be made to save the life of my child.

9. I direct my agent to firmly protect my rights and best interests, taking legal action if

necessary.

10. My agent shall not be held personally liable for any costs for taking legal action or for

medical goods or services purchased or contracted for in compliance with my wishes

regarding medical care and treatment, except as required by law.

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Protective Durable Power Of Attorney For Health Care Page 6