Living Will Form – Health Care Power of Attorney Form
The purpose of a Living Will declaration is to document your wish that life-sustaining treatment, including artificially or technologically supplied nutrition and hydration, be withheld or withdrawn if you are unable to make informed medical decisions and are in a terminal condition or in a permanently unconscious state.
1. Life-sustaining treatment means any health care, including artificially or technologically supplied nutrition and hydration, that will serve mainly to prolong the process of dying.
2. Terminal condition or terminal illness means an irreversible, incurable and untreatable condition caused by disease, illness or injury. Your physician and one other physician will have examined you and believe that you cannot recover and that death is likely to occur within a relatively short time if you do not receive life-sustaining treatment.
3. Permanently unconscious state means an irreversible condition in which you are permanently unaware of yourself and your surroundings. Your physician and one other physician must examine you and agree that the total loss of higher brain function...
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