CREATE A LIVING WILL

An Example

In the event I am unable to make an informed decision regarding my health care, I direct my health care providers to follow my instructions as set forth below.

a. If my death from a terminal condition is imminent and even if life-sustaining procedures are used and there is no reasonable expectation of my recovery, I direct
that my life not be extended by life-sustaining procedures, including the administration of nutrition and hydration artificially.

b. If I am in a persistent vegetative state, that is if I am not conscious and am not aware of my environment nor able to interact with others, and there is no reasonable expectation of my recovery within a medically appropriate period, I direct that my life
not be extended by life-sustaining procedures, including the administration of nutrition and hydration artificially.

c. If I have an end-stage condition, that is a condition caused by injury, disease, or illness, as a result of which I have suffered severe and permanent deterioration indicated by incompetency and complete physical dependency and for which, to a reasonable degree of medical certainty, treatment of the irreversible condition would be medically ineffective, I direct that my life not be extended by life-sustaining
procedures, including the administration of nutrition and hydration artificially.

By signing below, I indicate that I am emotionally and mentally competent to make this living will and that I understand its purpose and effect.

____________________________

(Signature Of Declarant)

____________________________

(Date)

The declarant signed or acknowledged signing this living will in my presence and based upon my personal observation the declarant appears to be a competent individual.
___________________________ (Witness)

___________________________ (Witness)

(Signature of Two Witnesses required)

Get this document notarized.