Medical Power Of Attorney And Texas Will To Live (Page 6 of 8) in pdf

C. OTHER SPECIAL CONDITIONS

(Be as specific as possible.)

________________________________________________________________________________________

(Cross off any remaining blank lines.)

IF I AM PREGNANT

D. Special Instructions for Pregnancy.

If I am pregnant, I direct my health care provider(s) and health care agent(s) to use all lifesaving procedures

for myself with none of the above special conditions applying if there is a chance that prolonging my life

might allow my child to be born alive. I also direct that lifesaving procedures be used even if I am legally

determined to be brain dead if there is a chance that doing so might allow my child to be born alive. Except

as I specify by writing my signature in the box below, no one is authorized to consent to any procedure for me

that would result in the death of my unborn child.

If I am pregnant, and I am not in the final stage of a terminal condition as defined above, medical procedures

required to prevent my death are authorized even if they may result in the death of my unborn child provided

every possible effort is made to preserve both my life and the life of my unborn child.

________________________________________________________________________________________

Signature of Declarant

DESIGNATION OF ALTERNATE HEALTH CARE AGENT

(You are not required to designate an alternate health care agent, but doing so can be helpful. An alternate

health care agent may make the same health care decisions as the designated health care agent if the

designated health care agent is unable or unwilling to act as your health care agent. If the health care agent

designated is your spouse, the designation is automatically revoked by law if your marriage is dissolved.)

If the person designated as my health care agent is unable or unwilling to make health care decisions for me, I

designate the following persons to serve as my health care agent to make health care decisions for me as

authorized by this document, who serve in the following order:

A. First Alternate Health Care Agent

(Name)__________________________________________________________________________________

(Address)________________________________________________________________________________

________________________________________________________________________________________

(Phone Number)___________________________________________________________________________

Page 6 of 8

Medical Power Of Attorney And Texas Will To Live Page 6