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5892.BLD
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1993-01-06
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#5892
@001 Please state the name of the person executing this document:
#5893 Has this person previously executed a living will?
#5894
#end control section
#5892
/* Paragraph 5892: Living Won't */
DECLARATION OF DESIRES AS TO MEDICAL CARE
I, @001, 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.
#5893
/* Para. 4731: Revocation of living will */
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.
#5894
/* 5894: end of the living wont */
Dated: _________________________________________
________________________________________________
Declarant