S.B. 664

VETOES

(4)    MY AGENT'S AUTHORITY BECOMES OPERATIVE (INITIAL THE OPTION THAT
APPLIES):

[—] WHEN MY ATTENDING PHYSICIAN AND A SECOND PHYSICIAN DETERMINE
THAT I AM INCAPABLE OF MAKING AN INFORMED DECISION REGARDING MY
HEALTH CARE; OR

[—] WHEN THIS DOCUMENT IS SIGNED.

(5)    MY AGENT IS TO MAKE HEALTH CARE DECISIONS FOR ME BASED ON ANY
HEALTH CARE INSTRUCTIONS I GIVE IN THIS DOCUMENT AND ON MY WISHES AS
OTHERWISE KNOWN TO MY AGENT. IF MY WISHES ARE UNKNOWN, MY AGENT IS TO
MAKE HEALTH CARE DECISIONS FOR ME IN ACCORDANCE WITH MY BEST
INTERESTS, TO BE DETERMINED BY MY AGENT IN LIGHT OF MY PERSONAL VALUES
AS OTHERWISE KNOWN TO MY AGENT.

(6)    MY AGENT SHALL NOT BE LIABLE FOR THE COSTS OF TREATMENT BASED
SOLELY ON THIS AUTHORIZATION.

HEALTH CARE DECISION MAKING FORMS

THE FOLLOWING FORMS ALLOW YOU TO MAKE SOME DECISIONS ABOUT
FUTURE HEALTH CARE ISSUES. FORM I, CALLED A "LIVING WILL", ALLOWS YOU TO
MAKE DECISIONS ABOUT LIFE PROLONGING LIFE-SUSTAINING PROCEDURES IF, IN
THE FUTURE, YOU HAVE YOUR DEATH FROM A TERMINAL CONDITION IS IMMINENT
DESPITE THE APPLICATION OF LIFE-SUSTAINING PROCEDURES OR YOU ARE IN A
PERSISTENT VEGETATIVE STATE. FORM II, CALLED AN "ADVANCE DIRECTIVE",
ALLOWS YOU TO SELECT A HEALTH CARE AGENT, GIVE HEALTH CARE
INSTRUCTIONS, OR BOTH. IF YOU USE THE ADVANCE DIRECTIVE, YOU CAN MAKE
DECISIONS ABOUT LIFE PROLONGING 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.
ALSO, DIFFERENT FORMS MAY ALSO BE USED.

PLEASE NOTE: IF YOU DECIDE TO SELECT A HEALTH CARE A GENT 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.

- 3304 -