DECLARATION OF DESIRES AS TO MEDICAL CARE

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 treatment even after a

terminal diagnosis, even if the life prolonging treatment will

delay the natural process of dying.

I have previously made a "living will" or other document

expressing a desire contrary to that specified herein, and by this

document I herewith revoke the same.

Dated: _________________________________________

________________________________________________ Declarant