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2006 LAWS OP MARYLAND
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522
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IS, AN INCURABLE CONDITION THAT WILL KEEP GETTING WORSE
CONTINUE IN ITS COURSE UNTIL DEATH AND THAT HAS ALREADY
RESULTED IN LOSS OF CAPACITY AND COMPLETE PHYSICAL
DEPENDENCY:
1. KEEP ME COMFORTABLE AND ALLOW NATURAL DEATH TO OCCUR I DO
NOT WANT ANY MEDICAL INTERVENTIONS USED TO TRY TO EXTEND MY
LIFE. I DO NOT WANT TO RECEIVE NUTRITION AND FLUIDS BY TUBE OR
OTHER MEDICAL MEANS.
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((OR))
2. KEEP ME COMFORTABLE AND ALLOW NATURAL DEATH TO OCCUR. I DO
NOT WANT MEDICAL INTERVENTIONS USED TO TRY TO EXTEND MY LIFE.
IF I AM UNABLE TO TAKE ENOUGH NOURISHMENT BY MOUTH, HOWEVER, I
WANT TO RECEIVE NUTRITION AND FLUIDS BY TUBE OR OTHER MEDICAL
MEANS.
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((OR))
3. TRY TO EXTEND MY LIFE FOR AS LONG AS POSSIBLE, USING ALL
AVAILABLE INTERVENTIONS IN ACCORDANCE WITH ACCEPTED MEDICAL
STANDARDS THAT IN REASONABLE MEDICAL JUDGMENT WOULD PREVENT
OR DELAY MY DEATH. IF I AM UNABLE TO TAKE ENOUGH NOURISHMENT
BY MOUTH, I WANT TO RECEIVE NUTRITION AND FLUIDS BY TUBE OR
OTHER MEDICAL MEANS.
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PAIN RELIEF
NO MATTER WHAT MY CONDITION, GIVE ME THE MEDICINE OR OTHER
TREATMENT I NEED TO RELIEVE PAIN.
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IN CASE OF PREGNANCY
(OPTIONAL, FOR WOMEN OF CHILD-BEARING YEARS ONLY; FORM VALID IF
LEFT BLANK)
IF I AM PREGNANT, MY DECISION CONCERNING LIFE-SUSTAINING
PROCEDURES SHALL BE MODIFIED AS FOLLOWS:
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EFFECT OF STATED PREFERENCES
(READ BOTH OF THESE STATEMENTS CAREFULLY. THEN, INITIAL ONE ONLY.)
1. I REALIZE I CANNOT FORESEE EVERYTHING THAT MIGHT HAPPEN AFTER I
- 2590 -
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