DURABLE HEALTH CARE POWER OF ATTORNEY
AND HEALTH CARE TREATMENT INSTRUCTIONS
LIVING WILL
PART I
INTRODUCTORY REMARKS ON
HEALTH CARE DECISION MAKING
You have the right to decide the type of health care you want. Should you become
unable to understand, make, or communicate decisions about medical care, your
wishes for medical treatment are most likely to be followed if you express those wishes in
advance by:
(1) naming a health care agent to decide treatment for you; and
(2) giving health care treatment instructions to your health care agent or
health care provider.
An advance health care directive is a written set of instructions expressing your wishes
for medical treatment. It may contain a health care power of attorney, where you
name a person called a "health care agent" to decide treatment for you, and a living
will, where you tell your health care agent and health care providers your choices
regarding the initiation, continuation, withholding, or withdrawal of life-sustaining
treatment and other specific instructions.
You may limit your health care agent's involvement in deciding your medical treatment
so that your health care agent will speak for you only when you are unable to speak for
yourself or you may give your health care agent the power to speak for you
immediately. THIS COMBINED FORM GIVES YOUR HEALTH CARE AGENT THE POWER TO
SPEAK FOR YOU ONLY WHEN YOU ARE UNABLE TO SPEAK FOR YOURSELF.
A living will cannot be followed unless your attending physician determines that you
lack the ability to understand, make, and communicate health care decisions for
yourself and you are either permanently unconscious or you have an end-stage
medical condition, which is a condition that will result in death despite the introduction
or continuation of medical treatment. You, and not your health care agent, remain
responsible for the cost of your medical care.
If you do not write down your wishes about your health care in advance, and if later
you become unable to understand, make, or communicate these decisions, those
wishes may not be honored because they may remain unknown to others.
A health care provider who refuses to honor your wishes about health care must tell you
of its refusal and help to transfer you to a health care provider who will honor your
wishes.
You should give a copy of your advance health care directive (a living will, health care
power of attorney or a document containing both) to your health care agent, your
physicians, family members, and others whom you expect would likely attend to your