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Declaration in Conformance with Missouri Statutes 459.015
Declaration in Conformance with Missouri Statutes 459.015 I have the primary right to make my own decisions concerning treatment that might unduly prolong the dying process. By this declaration I express to my physician, family and friends my intent. If I should have a terminal condition it is my desire that my dying not be […]
Continue reading...Directive to Physicians as Provided by the California Health and Safety Code: Section 7187
16. December 2008
Directive to Physicians as Provided by the California Health and Safety Code: Section 7187 DIRECTIVE TO PHYSICIANS Directive made this _________________ day of ___________. I, __________________, being of sound mind, willfully and voluntarily make known my desire that my life shall not be artificially prolonged under the circumstances set forth below, do hereby declare: 1. […]
Continue reading...Uniform Living Will (General)
14. December 2008
UNIFORM LIVING WILL OF ________________________________ To my family, my physician, my lawyer, my clergyman. To any medical facility in whose care I happen to be. To any individual who may become responsible for my health, welfare or affairs. Death is as much a reality as birth, growth, maturity and old age — it is the […]
Continue reading...Statutory Declaration in Conformance with Illinois Natural Death Act
12. December 2008
Statutory Declaration in Conformance with Illinois Natural Death Act, IL. Stat. 110 ½ Paragraph 703 DECLARATION OF ______________________ This declaration is made this __________ day of __________ 20___________. I, _____________________________, being of sound mind, willfully and voluntarily make known my desires that my moment of death shall not be artificially postponed. If at any time […]
Continue reading...Revocation of Previous Living Will and Medical Care Restrictions
10. December 2008
Revocation of Previous Living Will and Medical Care Restrictions I, ________________, desire to make aware that after mature reflection, and, being aware of the right under the law to decline life- sustaining treatment, that I wish, should I ever be unable to make decisions for myself concerning my medical treatment that I receive life sustaining […]
Continue reading...Directive to Physicians as Provided by Nevada Revised Statutes, Section 449.610
8. December 2008
Directive to Physicians as Provided by Nevada Revised Statutes, Section 449.610 DIRECTIVE TO PHYSICIANS Date __________________ I, _______________, being of sound mind, intentionally and voluntarily declare: 1. If at any time I should have an incurable injury, disease, or illness certified to be a terminal condition by two physicians, and where the application of life-sustaining […]
Continue reading...Statutory Declaration in Conformance with Florida Life Prolonging Procedure Act, F.S. 765.05
6. December 2008
Statutory Declaration in Conformance with Florida Life Prolonging Procedure Act, F.S. 765.05 DECLARATION OF ________________________ Declaration made this __________ day of _____________ 20________. I ___________ willfully and voluntarily make known my desire that my dying shall not be artificially prolonged under the circumstances set forth below, do hereby declare: If at any time I should […]
Continue reading...Statutory Declaration in Conformance with Indiana Living Will and Life-Prolonging Procedures Act, Indiana Code 16-8-11-12
5. December 2008
Statutory Declaration in Conformance with Indiana Living Will and Life-Prolonging Procedures Act, Indiana Code 16-8-11-12 LIVING WILL DECLARATION OF ________________ Declaration made this __________ day of _________________ 20________. I, _____________, being at least eighteen (18) years old and of sound mind, willfully and voluntarily make known my desires that my dying shall not be artificially […]
Continue reading...Declaration of a Desire for a Natural Death as Provided by North Carolina G.S. 90-321
4. December 2008
Declaration of a Desire for a Natural Death as Provided by North Carolina G.S. 90-321 I, ________________, being of sound mind, desire that my life not be prolonged by extraordinary means if my condition is determined to be terminal and incurable. I am aware and understand that this writing authorizes a physician to withhold or […]
Continue reading...Declaration as Provided by Montana Stats. 50-9-104
2. December 2008
Declaration as Provided by Montana Stats. 50-9-104 DECLARATION If I should have an incurable or irreversible condition that will cause my death within a reasonable short time, it is my desire that my life not be prolonged by administration of life-sustaining procedures. If my condition is terminal and I am unable to participate in decisions […]
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17. December 2008
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