WILLIAM DONALD SCHAEFER, Governor                         Ch. 372

(b) (1) A declarant is responsible for notifying the attending physician of the
existence of the declaration either directly or through another individual.

(2) Notice may be given by delivery of the declaration or a copy of the
declaration to the attending physician.

(3) The attending physician shall make the declaration or other written
documents containing a declaration in conformance with the provisions of subsection
(c)(1) of this section a part of the declarant's medical records.]

[(c) (1)] (A) [The declaration] A LIVING WILL shall be substantially in the
following form:

" [DECLARATION] LIVING WILL

On this ... day of ... (month, year), 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] THIS LIVING WILL BE GIVEN EFFECT AND
LIFE SUSTAINING PROCEDURES NOT BE USED IF (WRITE YOUR INITIALS NEXT TO
ONE OR BOTH OF THESE STATEMENTS):

____ I AM IN A TERMINAL CONDITION AND INCAPACITATED, AS DETERMINED

IN ACCORDANCE WITH LAW BY MY PHYSICIANS, WHO HAVE DETERMINED THAT MY
DEATH IS IMMINENT WHETHER OR NOT LIFE SUSTAINING PROCEDURES ARE USED,
AND THE USE OF THESE PROCEDURES WOULD SERVE ONLY TO PROLONG THE
DYING PROCESS.

____ I AM IN A PERSISTENT VEGETATIVE STATE, AS DETERMINED IN

ACCORDANCE WITH LAW BY MY PHYSICIANS, WHO HAVE DETERMINED THAT I
HAVE LOST PERMANENTLY ALL CAPACITY FOR THOUGHT, PURPOSEFUL ACTION,
AND AWARENESS OF SELF AND ENVIRONMENT.

UNDER THE CIRCUMSTANCES SET FORTH ABOVE, AS INDICATED BY MY
INITIALS, I DIRECT THAT LIFE SUSTAINING PROCEDURES be withhold or withdrawn,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] PROCEDURES TO THE EXTENT 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] LIVING WILL shall
be honored by my family and physician(s) as the final expression of my right to control my
medical care and treatment.

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