Yes, if at any point it is determined that it is not possible that the fetus could develop to the point of live birth with continued application of life-sustaining procedures, it is my preference that this document be given effect at that time.
LIW_GA04
vIf you have been diagnosed as pregnant, do you desire that this Living Will be enforced if the fetus will not survive?
LAL04003
Yes, if life-sustaining procedures will be physically harmful or unreasonably painful to me, I request that such harm or pain be considered in determining whether this document shall be effective if I am pregnant.
LIW_GA04
}Should pain or physical harm be considered in determining whether life-sustaining procedures should be withheld or withdrawn?
{NEXT_?}
Yes, include the section.
LIW_GA04
LDo you wish to state the effectiveness of this document if you are pregnant?
LAL04002
{NEXT_?}
Other requests:#|
LIW_GA05
^What other specific requests or instructions, if any, do you wish to include in this document?
If desired, use this space to state any other specific requests or instructions.
{NEXT_?}
LAL05255
SEVERABILITY. If any provision in this document is held to be invalid, such invalidity shall not affect the other provisions which can be given effect without the invalid provision, and to this end the directions in this document are severable.
LIW_GA06
3Do you wish to include this severability provision?
{NEXT_?}
Name: |
LIW_GA01
+Who is this Living Will being prepared for?
{NEXT_?}
Yes, procedures should be withheld or withdrawn.
LIW_GA02
Is it your desire that your life NOT be prolonged by life sustaining procedures if you are determined to be comatose, with no reasonable expectation of regaining consciousness?
A Living Will directs the Declarant's physician to withdraw or withhold life sustaining procedures if the Declarant is in a terminal condition with no hope of recovery. Enter an X if the Declarant also wants such procedures withdrawn or withheld if he or she is comatose.
{NEXT_?}
YesNo
LIW_GA03
KDo you wish to receive artificially administered nourishment and hydration?
Enter an X if you WISH TO RECEIVE artificially administered nutrition and hydration, even though there is no hope of recovery from your condition.
Enter an X if you DO NOT WISH TO RECEIVE artificially administered nutrition and hydration, even though there is no hope of recovery from your condition.
{NEXT_?}
Yes, include the paragraph.
LIW_GA03
RDo you wish to include information regarding artificial nourishment and hydration?
WGA03001
{NEXT_?}
In the absence of my ability to give directions regarding the use of such life-sustaining procedures, it is my intention that this Living Will shall be honored by my family and physician(s) as the final expression of my legal right to refuse medical or surgical treatment and I accept the consequences from such refusal.
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