Health Care Directive (Living Will) (Page 2 of 4) in pdf

Health Care Directive (Living Will) Page 2

Page 1 of 3

To my family, my friends, my physicians, and all others whom

it may concern:

I, _________________________________________________

voluntarily make this directive concerning my health care in the circum-

stances set out herein.

I believe that when there is no reasonable expectation of recovery

from disease or injury, the continuation of my life by life support systems

or medical therapy will be contrary to my right of autonomy.

It is my intention that this Directive be respected by my physician,

my family, and friends, if I am no longer capable of consenting to health

care on my own behalf.

DIRECTIVE

This directive shall apply in the event that:

(a)

I am no longer able to make or communicate decisions for

my own health care.

(b)

there is no reasonable expectation of my recovery from

extreme physical or mental disability, of if I am afflicted with

irreversible injury, disease or illness.

For the purpose of determining whether the circumstances set out

in Number 1 exist, I stipulate that when possible, the opinion of

two medical doctors who have examined me shall be determina-

tive.

When death is inevitable, I would accept the performance of any

procedure or administration of medication deemed necessary to

provide me with compassionate care and comfort.

Where the application of medical procedures would primarily

serve to prolong the moment of my death or maintain my life

in the circumstances set out in Part 1, I direct that such procedures

be withheld or withdrawn and that I be permitted to die naturally.

S:EHCMy Documents 2008Palliative CareHealth Care DirectiveAdvanced Health Care Directive.doc

Health Care Directive (Living Will) Page 2