Living will and health care proxy. Directive not to sustain life by artificial measures.

Document Outline:

TO MY FAMILY, MY PHYSICIANS, ANY MEDICAL FACILITY HAVING RESPONSIBILITY FOR MY CARE, AND ALL OTHERS CONCERNED WITH MY WELL-BEING OR AFFAIRS:

I, , hereby appoint ... 

In the event I ...

This health care proxy ...

Without limiting in any way ...

I do, however, ask that ...

This request is made after careful ...

I direct my health care agent to ...

If my health care agent named above is unable ...

I request, but do not direct, that...

I understand that, unless I revoke it, this proxy will remain in effect indefinitely.

IN WITNESS WHEREOF, I have signed this instrument on .

I declare ...
Witnesses:

Wills & Codicils