Durable Power Of Attorney For Health Care Decisions Page 7
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12(C) Artificial Nutrition and Hydration.
If I am unable to safely take
nutrition, fluids, or nutrition and fluids (check your choices or write your instructions),
[ ] I wish to receive artificial nutrition and hydration indefinitely;
[ ] I wish to receive artificial nutrition and hydration indefinitely, unless it
clearly increases my suffering and is no longer in my best interest;
[ ] I wish to receive artificial nutrition and hydration on a limited trial
basis to see if I can improve;
[ ] In accordance with my choices in (6)(B) above, I do not wish to receive
artificial nutrition and hydration.
[ ] Other instructions
(D) Relief from Pain.
[ ] I direct that adequate treatment be provided at all times for the sole
purpose of the alleviation of pain or discomfort; or
[ ] I give these instructions:
(E) Should I become unconscious and I am pregnant,
I direct that
(7) OTHER WISHES.
(If you do not agree with any of the optional choices above
and wish to write your own, or if you wish to add to the instructions you have
given above, you may do so here.)
I direct that
________________________________________________________________
_
___________________________________________________________________
Conditions or limitations:
(Add additional sheets if needed.)
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Parent category: Legal