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1993-01-06
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#5005
@001 State the name of the declarant:
#end control section
#5005
/* Connecticut Living Will*/
LIVING TESTAMENT AS PROVIDED BY CONNECTICUT STATUTES
SECTION 19a-575
TESTAMENT
If the time comes when I am incapacitated to the
point where I can no longer actively take part in decisions
for my own life, and am unable to direct my physician as to
my own medical care, I wish this statement to stand as a
testament of my wishes. I @001 request that I be allowed to die
and not be kept alive through life support system if my condition
is deemed terminal. I do not intend any direct taking of my life,
but only that my dying not be unreasonably prolonged.
This request is made, after careful reflection, while I am of
sound mind.
Signed ______________________________________________
@001
Witness __________________________________________________
Witness __________________________________________________