Fillable Living Will Form (Page 3 of 10) in pdf

make or communicate your decisions about your medical care. The health care agent may tell your physician

what your wishes are regarding life support treatment and may take the steps necessary to ensure that your

wishes are fulfilled. Your physician will ask your health care agent what your wishes were regarding life

support treatment if he does not have a living will from you. Thus, the health care agent can be a "back-up"

for your living will if it becomes unavailable and can take action if your wishes are being ignored.

It is important to understand that a health care agent cannot represent your wishes on decisions other than

whether to withhold or withdraw life support systems. For example, the decisions to provide you physical

therapy or to get second opinions cannot be made by a health care agent.

You can appoint a person to make such other medical care decisions on your behalf through a durable power

of attorney. In addition, a court can appoint someone as your conservator to make such decisions.

What is an attorney-in-fact for health care decisions? An attorney-in-fact for health care decisions is a

person whom you name in a document called a durable power of attorney, to make medical decisions other

than withdrawal of life support systems on your behalf should you become unable to make or communicate

such decisions yourself. Your attorney-in-fact may make decisions about any aspect of your medical

treatment except in three areas. He or she may not make decisions regarding: (1) withdrawal of life support

systems; (2) withdrawal of food and fluids; and (3) medical treatment designed solely to maintain your

physical comfort.

What is a conservator? A "conservator of the person" is someone appointed by the Probate Court when

the Court finds that a person is incapable of caring for himself/herself including the inability to make

decisions about his or her medical care. The conservator of the person has responsibility for the general

custody and care of the incapable individual and has the power to give consent for the medical care,

treatment and services provided to the incapable person. You can name in advance the person you want the

Court to appoint as your conservator if you become incapable of making your own decisions. If you have a

conservator, he or she will be consulted in all medical care decisions. If you have a living will, however, the

conservator's consent is not required to carry out your wishes as expressed in the living will.

What advance directives should I have? If you want to be sure that your wishes about your medical care

are known if you cannot express them yourself, you should have a living will, a health care agent and an

attorney-in-fact for health care decisions. Each of these directives has a special importance.

If you are unable to make or communicate your preferences as to your general medical care, your attorney-

in-fact for health care decisions can make those decisions for you. However, if the decision is whether to

withhold or withdraw a life support system, your attorney-in-fact for health care decisions cannot make the

decision. Life support decisions can be made with your health care agent and living will.

On the question of life support, your physician will look first to your living will as the source of your wishes.

If your physician does not have a living will for you, then your health care agent can inform your physician

what your wishes were regarding life support systems. In addition, your health care agent can take the steps

necessary to ensure that your wishes are given effect.

Thus, for general health care decisions, a durable power of attorney should be created. For decisions

regarding life support systems, a living will and an appointment of health care agent is recommended.

THIS IS A SAMPLE AND OFFERED SOLELY FOR THE ASSISTANCE OF ATTORNEYS WHO WILL BE RESPONSIBLE FOR THE

ULTIMATE SUBSTANCE AND WORDING OF THE DOCUMENT. THE USE OF THIS SAMPLE BY PARTIES OTHER THAN ATTORNEYS

IS NOT AUTHORIZED

Living Will Form Page 3