Combined Living Will And Health Care Power Of Attorney (Page 3 of 5) in pdf

III.

DECLARATION OF LIVING WILL

I direct that those responsible for my care to make health care decisions according to the principles and

authoritative teachings of my Catholic faith and what they know about my stated wishes. I hereby declare

and make known my instructions and wishes for my future health care.

This LIVING WILL shall take effect when my attending physician determines that I am incompetent which

means that I lack sufficient capacity to understand the potential material benefits, risks and alternatives

involved in a specific proposed health care decision; I am unable to make the health care decision on my

behalf; or I am unable to communicate a decision about my health care.

For the LIVING WILL to be effective, my attending physician must also verify that:

I have an end-stage medical condition, that is, I have an incurable and irreversible medical condition

in an advanced state which will result in death despite the introduction or continuation of medical treatment;or

I am permanently unconscious, which is a total and irreversible loss of consciousness and capacity

for interaction with the environment.

To inform those responsible for my care of my specific wishes, I direct that the following health care decisions

be implemented. I affirm that the statements and principles listed in the Preamble and in my HEALTH CARE

POWER OF ATTORNEY which are part of this form apply, as well, to this LIVING WILL.

I ask that if I fall terminally ill, I be told so I might prepare myself for death. If I am unable to understand,

communicate or make decisions for myself, I direct that a Catholic priest be contacted to attend to my

spiritual needs so I may receive the Sacraments of Reconciliation and the Anointing of the Sick, Viaticum, and

be supported by prayer.

If my doctor determines that I have an end-stage medical condition and my death is imminent, I direct that

treatment that will only maintain a precarious and burdensome prolonging of my life be foregone or withdrawn.

However, treatment should not be withdrawn if my health care agent (or in the absence of a health care

agent, my health care representative) judges there are special and significant reasons why it should continue.

I believe that I do not have to use ethically extraordinary or disproportionate medical treatments for sustaining

life if they are excessively burdensome or do not offer any reasonable hope of benefit. I understand that this

belief is consistent with authoritative Catholic teaching.

I direct that, regardless of my physical or mental condition, all ordinary medical care necessary to relieve pain

and make me comfortable (including medically assisted nutrition and hydration) be provided if it offers a

reasonable hope of benefit and is not excessively burdensome.

If I am unable (even with assistance) to take food and drink orally, I desire that medically assisted nutrition

and hydration be provided to me so long as it is capable of sustaining my life. Even if I am permanently

unconscious, medically assisted nutrition and hydration should be continued. It should be discontinued if it is

futile (no longer able to sustain my life). It should be discontinued if it imposes disproportionate burdens to me

(serious risk, excessive pain, excessive expense on the family or the community, or some other extreme

burden) or if death is both inevitable and so imminent that continuing medically assisted nutrition and hydration

is judged futile.

I direct that I receive appropriate medication to alleviate my pain, even though the administration of such

medications may indirectly hasten my death. Pain medication should never be administered with the purpose

of hastening my death.

I also direct that I not receive ethically extraordinary treatments, unless my health care agent (or representative)

judges that there are special and significant reasons why I should receive them. Rather than listing for my

agent all specific forms of medical treatment, which I would or would not want, I direct that the directions and

principles I have adopted by using this form guide him or her.

Additional Provisions for a Woman: I direct that if I am pregnant all medically indicated measures and

medically assisted nutrition and hydration be provided to sustain my life, regardless of my physical or mental

condition, if these measures could sustain the life of my unborn child until birth.

Page 3

Combined Living Will And Health Care Power Of Attorney Page 3

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