I ………………………………………………………………………………………………….
Being of sound mind, I voluntarily state my desires that under the circumstances stated under this document, I intend that my family, physician or any other party may honor this document as my final expression of legal rights. I also wish to request that, if I develop a terminal condition or if my physician describes me as permanently unconscious, I wish to be allowed to die and not be kept alive through life support systems.
The wishes in this document should take effect in case of the following:
1. If I am in a state of health that am not able to make life decisions as determined by a physician and thus not able to participate in making decision about my health options.
2. A state where am not able recognize my friends and family member.
3. A state of health where am not able to communicate my desires about health options.
The following are my wishes on different scenarios and states of health and the kind of treatment I would prefer:
- If I have a terminal condition as determined by two different physicians who have personally and separately examined me, I would not wish my life to be prolonged artificially through any life sustaining procedure.
- In case of a treatment that would take longer than one year with chances of regaining my life in doubt and the doctor states that it will be painful, I wish for the treatment not to be administered.
- My preference on day-to-day care is to be taken care of by a family member at home, never be bathed by no other than a family member.
- In case of a terminal illness like stroke that incapacitate me, then I wish that spoon feeding by a family member should be effected and if it fails, I would be fed through tubes.
- In case am diagnosed with chronic kidney failure and the only way to keep surviving is through dialysis, then I would prefer not to have it and be taken care of from home.
- Ventilation or use of artificial breathing system would be administered as long as its to help save a situation but not as a way or