Durable Power Of Attorney For Health Care Choices & Health Care Choices Directive Page 3
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DURABLE POWER OF ATTORNEy FOR HEALTH CARE & HEALTH CARE DIRECTIVE
Part II. Health care choices directive
I want those involved in my health care to understand my wishes if I cannot communicate or
make decisions on my own. I make this directive to provide clear and convincing proof of
my wishes and instructions about my health care and treatment.
If my doctor believes medical treatment will lead to my recovery, I want to have the
treatment. I also want to have care and treatment for pain or discomfort even if this
treatment might shorten my life, affect my appetite, slow my breathing or be habit-forming.
If I have a terminal illness or condition and there is no reasonable hope I will
recover, or if I am persistently unconscious, I direct all of the life-prolonging
procedures I have initialed below to be withheld or withdrawn.
I direct the following treatments to be withheld or withdrawn:
Surgery or other invasive procedures
Cardiopulmonary resuscitation (CPR) to restart my heart or breathing
Antibiotics
Dialysis
Mechanical ventilator (respirator)
Artificially supplied nutrition and hydration (including tube feeding)
Chemotherapy
Radiation therapy
All other “life-prolonging” medical treatments or surgeries that are merely intended to
keep me alive without reasonable hope of making me better or curing my illness or injury.
I consent to the donation of my organs or tissues. I realize my body may need to be
maintained artificially after my death until my organs can be removed.
I refuse to make anatomical gifts of part or all of my body. I prohibit my agent from
consenting to such gifts before or after my death.
COMMUNICATING ABOUT THE END OF LIFE
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