Catholic Declaration On Life And Death printable pdf download

Catholic Declaration On Life And Death

CATHOLIC DECLARATION ON LIFE AND DEATH

ADVANCE DIRECTIVE - CALIFORNIA

(HEALTH SURROGATE DESIGNATION/LIVING WILL) OF

(Name)

Introduction

I am executing this Catholic Declaration on Life and Death while I am of sound mind. It is intended

to clarify my wishes for treatment in situations that may arise in which I am incapacitated or unable

to express these wishes.

Statement of Faith

I believe that I have been created for eternal life in union with God. The truth that my life is a

precious gift from God has profound implications for the question of stewardship over my life. I

have a duty to preserve my life and to use it for God’s glory, but the duty to preserve my life is not

absolute, for I may reject life-prolonging procedures that are insufficiently beneficial or excessively

burdensome. Suicide and euthanasia are never morally acceptable options.

If I should become

irreversibly and terminally ill, I request to be fully informed of my condition so that I can prepare

myself spiritually for death and witness to my belief in Christ’s redemption.

Designation of Health Care Surrogate

In the event that I become incapacitated I designate as my surrogate for health care decisions (if no

surrogate is to be appointed, please write “none” in place of “name” below):

Name:

Address:

Phones (Home, Work, Cell):

If my surrogate is unwilling or unable to perform his or her duties or cannot be contacted, I wish to

designate as my alternate surrogate (if no alternate surrogate is to be appointed, please write “none”

in place of “name” below):

Name:

Address:

Phones (Home, Work, Cell):

This directive will permit my surrogate to make health care decisions, and to provide, withhold, or

withdraw consent on my behalf; to apply for public benefits to defray the cost of health care; to

receive my personal health care information; and to authorize my admission to or transfer from a

health care facility. It is not being made as a condition of treatment or admission to a health care

facility. This document must be signed and witnessed to be valid.

Cf United States Conference of Catholic Bishops, Ethical & Religious Directives for Catholic Health Care Services (USCCB:

Washington, DC 2001), Part Five

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Catholic Declaration On Life And Death