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