Sample Heath Care Directive

The tragic Terri Schiavo case makes it clear that everyone needs to make their wishes clear should they become very seriously ill or injured. Fortunately this is easy to do and the documents are very legally forceful. It does not require a lawyer, though it can be useful to consult one if you’re not sure about something. What is needed is a Health Care Directive. There are two forms that make up a Health Care Directive. They are: A Living Will and a Medical Power of Attorney. A Living Will says what care you want to receive. The Medical Power of Attorney gives someone the power to make medical decisions if you cannot make them for yourself. These can be two separate forms or combined into one form. There are many fine free sites on the web that will produce a document for you by answering a few questions. You can if you like just type or write out in longhand a simple document that makes your wishes clear. Here is a sample of one for someone who does not want to be maintained should there be no reasonable expectation of recovery.

Sample Heath Care Directive

Living Will and Medical Power of Attorney

Should I be in an incurable or irreversible mental or physical condition with no reasonable expectation of recovery, I direct my physician to withhold or withdraw all treatment that merely prolongs my dying. I further direct that my treatment be limited only to measures that keep me comfortable and relieve pain.

If there is no reasonable chance for recovery even if death is not imminent:

I do not desire that nutrition and hydration be provided by gastric tube or intravenously.
I do not desire the use of a respirator if I cannot breathe.
I do not desire treatment with antibiotics if pneumonia or any other infection develops.
I do not desire cardiopulmonary resuscitation to start my heart beating.
I do not desire any other heroic or life-prolonging procedures.

I have discussed this in detail with (fill in the name). We have reached a full meeting of the mind concerning my desires to maintain only a quality and dignified life. I give (fill in the same name) full Medical Power of Attorney. I direct that should there be any controversy of question concerning any wording or interpretation of this will that (he/she)
and (he/she) alone shall decide what is in my best interest.

Witness________________Date______________
Witness________________Date______________

Being of sound mind and body I sign this Living Will and Medical Power of Attorney on Date____________ before the witnesses indicated.

Your Signature ____________________________