Medical Power Of Attorney And Texas Will To Live (Page 4 of 8) in pdf

MEDICAL POWER OF ATTORNEY

and TEXAS WILL TO LIVE

I, (your name)____________________________________________________________________________

(your address)____________________________________________________________________________

________________________________________________________________________________________

(your phone number)_______________________________________________________________________

appoint:

(name of health care agent)__________________________________________________________________

(address of health care agent)________________________________________________________________

(phone number(s) of health care agent)_________________________________________________________

as my health care agent to make any and all health care decisions for me, except to the extent I state otherwise

in this document. This Medical Power of Attorney takes effect if I become unable to make my own health

care decisions and this fact is certified in writing by my physician.

LIMITATIONS ON THE DECISION MAKING AUTHORITY OF MY HEALTH CARE AGENT

FOLLOW.

GENERAL PRESUMPTION FOR LIFE

I direct my health care provider(s) and health care agent(s) to make health care decisions consistent with my

general desire for the use of medical treatment that would preserve my life, as well as for the use of medical

treatment that can cure, improve, reduce or prevent deterioration in, any physical or mental condition.

Food and water are not medical treatment but basic necessities. I direct my health care provider(s) and health

care agent to provide me with food and fluids orally, intravenously, by tube, or by other means to the full

extent necessary both to preserve my life and to assure me the optimal health possible.

I direct that medication to alleviate my pain be provided, as long as the medication is not used in order to

contribute to, hasten, or cause my death. I direct that the following be provided to the full extent necessary to

correct, reverse, or alleviate life-threatening or health impairing conditions or complications arising from

those conditions:

a) the administration of medication,

b) cardiopulmonary resuscitation (CPR), and

c) the performance of all other medical procedures, techniques, and technologies, including

surgery.

I also direct that I be provided basic nursing care and procedures to provide comfort care.

Page 4 of 8

Medical Power Of Attorney And Texas Will To Live Page 4