Durable Power Of Attorney For Health Care Template Page 5
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Many medical treatments may be used to try to improve my medical condition in certain
circumstances or to prolong my life in other circumstances. Many medical treatments can be
started and then stopped if they do not help. Examples include artificial breathing by a machine
connected to a tube in the lungs, artificial feeding or fluids through tubes, attempts to start the
heart, surgeries, dialysis, antibiotics, and blood transfusions. The back inside page has more
information about life-support measures.
OPTIONAL -FOR DISCUSSION PURPOSES
A discussion of these questions with your health care agent may help him or her make health
care decisions for you which reflect your values when you cannot make those decisions.
These are my views which may help my agent make health care decisions:
1. Do you think your life should be preserved for as long as possible? Why or why not?
2. Would you want your pain managed, even if it makes you less alert or shortens your life?
3. Do your religious beliefs affect the way you feel about death? Would you prefer to be
buried or cremated?
4. Should financial considerations be important when making a decision about medical care?
5. Have you talked with your agent, alternative agent, family and friends about these issues?
_____ My Initials
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