Yesterdays People by Gail Gibson - HTML preview

Guideline for a living will

I, . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . (full name), in making this Living Will, wish to confirm that I

• am 18 years or older;
• am of sound mind;
• act of my own free will, free from duress induced by others; and
• have carefully considered my own values, beliefs and preferences, as
• well as misfortunes of body and/or mind that may befall me.

Hence, should I, as a result of illness, injury or any other trauma, at a future date,

• develop a terminal and incurable medical condition; or
• become permanently vegetative; or
• become completely and irreversibly unconscious,

and, as a consequence, no longer possess the requisite rationality or competence to have or communicate my health care decisions, I grant authority to and authorise any medical professional and/or medical facility and/or other carer to execute this Living Will, thereby allowing me to die a natural death by refraining from keeping me alive by artificial means, or by potentially life-sustaining medical intervention, treatment or procedure, such as:

• artificial nutrition;
• artificial hydration;
• dialysis;
• any medication or drug, including antibiotics, administered through
• any method, including an IV tube; or
• life support of any kind.

[The maker of a Living Will is free to insert a clause instructing an attending or treating  medical doctor/health care professional, or any other person, not to discontinue a specific form of life-sustaining treatment, for example, artificial hydration.]

In addition, I authorise any attending medical professional and/or medical facility and/or other carer to administer to me comfort or palliative care, specifically adequate medication to alleviate my pain and suffering, even though it might hasten my natural death as a secondary consequence.

Moreover, I give permission for any of my organs or tissue to be donated for legitimate medical or scientific purposes. [This clause may be excluded.]   [Recommend: A clause may also be included on costs as these may be recouped from the family.]

Moreover, I give permission for any of my organs or tissue to be donated for legitimate medical or scientific purposes, however I direct that the costs of such donation should be borne by the recipients of such organs or tissue and not by my estate.

WITNESS 1 to the signing of this Durable Power of Attorney for Health Care I declare that I have witnessed the signing of this Durable Power of Attorney for Health Care by (i) its grantor/maker and (ii) witness 2.

WITNESS 2 to the signing of this Durable Power of Attorney for Health Care I declare that I have witnessed the signing of this Durable Power of Attorney for Health Care by (i) its grantor/maker and (ii) witness 1.