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ROBERT L. EHRLICH, JR., Governor Ch. 137
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advance directive, you can make decisions about life-sustaining procedures in the
event of terminal condition, persistent vegetative state, or end-stage condition. You
can also use the advance directive to make any other health care decisions.
These forms are intended to be guides. You can use one form or both, and you
may complete all or only part of the forms that you use. Different forms may also be
used.
Please note: if you decide to select a health care agent that person may not be a
witness to your advance directive. Also, at least one of your witnesses may not be a
person who may financially benefit by reason of your death.
Form I
Living Will
(Optional Form)
If I am not able to make an informed decision regarding my health care, I direct
my health care providers to follow my instructions as set forth below. (Initial those
statements you wish to be included in the document and cross through those
statements which do not apply.)
a. If my death from a terminal condition is imminent and even if
life-sustaining procedures are used 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.
______ I direct that my life not be extended by life-sustaining procedures, except
that, if I am unable to take food by mouth, I wish to receive nutrition and hydration
artificially.
______ I direct that, even in a terminal condition, I be given all available medical
treatment in accordance with accepted health care standards.
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.
______ I direct that my life not be extended by life-sustaining procedures, except
that if I am unable to take in food by mouth, I wish to receive nutrition and hydration
artificially.
______ I direct that I be given all available medical treatment in accordance with
accepted health care standards.
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