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LIVING WILL

 

THE "LIVING WILL"

WHAT DOES IT DO? 

It is a document in which you convey your wishes regarding your medical care if you are in a permanent vegetative state or terminal condition.  A Living Will gives you the ability to name another person to make medical care decisions for you if you are unable to make those decisions.

WHY YOU NEED ONE:
 Family members might not agree as to what should be done if you are in a permanent vegetative state or terminal condition.
 Family members and your doctor might not take the action that you would want to be taken
Your doctor might hesitate to withhold extraordinary measures if your wishes are not stated clearly.
Special religious considerations.
Talk to your physician at your next appointment about a Living Will.  Ask the physician how they will transfer the information in your Living Will to your medical chart for interpretation by hospital staff.

PENNSYLVANIA RULES ON LIVING WILLS:
Pennsylvania has an ''Advance Directive for health-care Act.'' The Act defines ''life-sustaining treatment'' as ''[a]ny medical procedure or intervention that, when administered to a qualified patient, will serve only to prolong the dying process or to maintain the patient in a state of permanent unconsciousness'' and includes artificially administered nutrition and hydration.  A living will is effective when the attending physician determines that the declarant is incompetent and is in a state of permanent unconsciousness or is suffering from a terminal condition.  It does not apply to emergency services administered before such determination.  The statutory form that may be used for a living will allows a person to indicate desires with respect to seven different treatments, including kidney dialysis and antibiotics.

Nutrition, hydration and life sustaining treatments must be provided to a pregnant women who is incompetent unless the attending physician and obstetrician determine that it will not ''permit the continuing development and live birth of the unborn child'' or will be physically harmful to the pregnant women or will cause her pain that cannot be alleviated without medication.

Pennsylvania has a general durable power of attorney with no special provisions or references to health-care powers.

 

FREE COPY OF LIVING WILL (below)

 Here's what to do with the document:

Highlight and copy the form into a Word Document to make the following changes

 Check the boxes that you want to apply

You can change the time period applicable (14 DAYS) to whatever amount of time you are comfortable with

Fill your address and county you live in where there are blank spaces

 List a name of your surrogate under "Other Instructions" (person you want to make decisions for you in this case)

Sign and date it

Have witness sign it

 The document need NOT be notarized, however it is a good idea to have witnesses sign it and have it notarized to lend some confidence that the document will be honored in jurisdictions other than Pennsylvania.  You can make multiple copies and give one to your physician and surrogate. 

These instructions apply if I am:

(a) in a terminal condition,

(b) permanently unconscious but have irreversible brain damage and will never regain the ability to make decisions and express my wishes.

I direct that treatment be limited to measures to keep me comfortable and to relieve pain, including any pain that might occur by withholding or withdrawing treatment.

If I am in the condition(s) described above for a period of FOURTEEN (14) days, I feel especially strongly about the following forms of treatment:

Initial boxes which apply:

I (  ) do (  ) do not want cardiac resuscitation.

I (  ) do (  ) do not want mechanical respiration.

I (  ) do (  ) do not want tube feeding or any artificial form of nutrition (food) or hydration (water).

 I (  ) do (  ) do not want blood or blood products.

 I (  ) do (  ) do not want any form of surgery or invasive diagnostic tests.

 I (  ) do (  ) do not want kidney dialysis.

 I (  ) do (  ) do not want antibiotics.

 Other Instructions:

 I, ________________, of _______________________  (address) located in ___________ County, do hereby designate:

 
Name:    ____________________________________________

Relationship:   _______________________________________

Address:          _______________________________________

                         ________________________________________

Telephone Numbers:      (xxx) xxx-xxxx (Home)

as my surrogate to make medical treatment decisions for me if I should be incompetent and in a terminal condition or in a state of permanent unconsciousness.

In the hope that I may help others, I have indicated by mark the anatomical gifts I am willing to make:

[ ] eyes

[ ] kidney

[ ] any organ

[ ] inner ears

[ ] liver

[ ] any body part

[ ] skin

[ ] blood

[ ] my complete body to science

[ ] heart

[ ] veins and arteries

These directions express my legal right to refuse medical treatment as a liberty interest available to me by reason of the Due Process Clause of the United States Constitution.

I hereby approve, ratify, and confirm any action taken by my said agent(s) and substitutes appointed hereunder, until this Declaration is duly revoked under my hand and seal.  This Advance Health Care Declaration and grant of powers thereunder to my agent(s) and substitute agent(s) shall not be affected by my disability, incapacity, incompetency, or by uncertainty as to whether I am dead or alive.

I have signed this Advance Health Care Declaration this _________________ day of _________________ , 200_.

 

_____________________________
JOHN DOE

 

________________________________    
(Witness)

 

 ________________________________
(Witness)          

 

ADVANCED HEALTHCARE DECLARATION
OF
JOHN DOE

TO MY FAMILY, MY PHYSICIAN, MY CLERGYMAN, MY LAWYER, MY ATTORNEY-IN-FACT UNDER A DURABLE POWER OF ATTORNEY, IF ANY, AND MY COURT APPOINTED GUARDIAN OR SURROGATE, IF ANY:

I, JOHN DOE, being of sound mind, make this statement as a directive to be followed if I become incompetent, incapacitated or in any way permanently unable by reason of a physical and or mental disability to participate in decisions regarding my medical care.  These instructions reflect my firm and settled commitment to refuse medical treatment under the circumstances indicted below.

I direct my attending physician to withhold or withdraw treatment that serves only to prolong the process of my dying, if I should be in an incurable or irreversible physical and or mental condition with no reasonable expectation of recovery.

 


 

 





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