Durable Health Care Power Of Attorney And Health Care Treatment Instructions (Page 2 of 9) in pdf

needs if you become unable to understand, make, or communicate decisions about

medical care.

If your health care wishes change, tell your physician and write a new advance health

care directive to replace your old one. It is important in selecting a health care agent

that you choose a person you trust who is likely to be available in a medical situation

where you cannot make decisions for yourself. You should inform that person that you

have appointed him or her as your health care agent and discuss your beliefs and

values with him or her so that your health care agent will understand your health care

objectives.

You may wish to consult with knowledgeable, trusted individuals such as family

members, your physician, or clergy when considering an expression of your values and

health care wishes. You are free to create your own advance health care directive to

convey your wishes regarding medical treatment.

The following form is an example of an advance health care directive that combines a

health care power of attorney with a living will.

NOTES ABOUT THE USE OF THIS FORM

If you decide to use this form or create your own advance health care directive, you

should consult with your physician and your attorney to make sure that your wishes are

clearly expressed and comply with the law.

If you decide to use this form but disagree with any of its statements, you may cross out

those statements. You may add comments to this form or use your own form to help

your physician or health care agent decide your medical care.

This form is designed to give your health care agent broad powers to make health care

decisions for you whenever you cannot make them for yourself. It is also designed to

express a desire to limit or authorize care if you have an end-stage medical condition or

are permanently unconscious.

If you do not desire to give your health care agent broad powers, or you do not wish to

limit your care if you have an end-stage medical condition or are permanently

unconscious, you may wish to use a different form or create your own. You should also

use a different form if you wish to express your preferences in more detail than this form

allows or if you wish for your health care agent to be able to speak for you immediately.

In these situations, it is particularly important that you consult with your attorney and

physician to make sure that your wishes are clearly expressed.

This form allows you to tell your health care agent your goals if you have an end-stage

medical condition or other extreme and irreversible medical condition, such as

advanced Alzheimer's disease. Do you want medical care applied aggressively in

these situations or would you consider such aggressive medical care burdensome and

undesirable?

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