Ch. 11                      LAWS OF MARYLAND

The stylistic error was noted by the Michie Company.

(c) (1) The declaration shall be substantially in the
following form:

"DECLARATION

On this______ day of                                   (month, year), [I,

____] I, ____________, being of sound mind,

willfully and voluntarily direct that my dying shall not be
artificially prolonged under the circumstances set forth, in this
declaration:

If at any time I should have an incurable injury, disease,
or illness certified to be a terminal condition by two (2)
physicians who have personally examined me, one (1) of whom shall
be my attending physician, and the physicians have determined
that my death is imminent and will occur whether or not
life-sustaining procedures are utilized and where the application
of such procedures would serve only to artificially prolong the
dying process, I direct that such procedures be withheld or
withdrawn, and that I be permitted to die naturally with only the
administration of medication, the administration of food and
water, and the performance of any medical procedure that is
necessary to provide comfort care or alleviate pain. In the
absence of my ability to give directions regarding the use of
such life-sustaining procedures, it is my intention that this
declaration shall be honored by my family and physician(s) as the
final expression of my right to control my medical care and
treatment.

I am legally competent to make this declaration, and I
understand its full import.

Signed______________________________
Address_____________________________

Under penalty of perjury., we state that this declaration was

signed by ______________________ in the presence of the

undersigned who, at _______ request, in ___ presence, and in

the presence of each other, have hereunto signed our names as
witnesses this _______ day of ____ 19___. Further, each of us,
individually, states that: The declarant is known to me, and I
believe the declarant- to be of sound mind. I did not sign the
declarant's signature to this declaration. Based upon
information and belief, I am not related to the declarant by
blood or marriage, a creditor of the declarant, entitled to any

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