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_SC07
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_SC07
}Should pain or physical harm be considered in determining whether life-sustaining procedures should be withheld or withdrawn?
{NEXT_?}
Yes, include the section.
LIW_SC07
LDo you wish to state the effectiveness of this document if you are pregnant?
LAL04002
{NEXT_?}
Other requests:#|
LIW_SC08
^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_SC09
3Do you wish to include this severability provision?
{NEXT_?}
Name: |City: |County: |
LIW_SC01
+Who is this Living Will being prepared for?
{NEXT_?}
Yes, procedures should be withheld or withdrawn.
LIW_SC02
Is it your desire that your life NOT be prolonged by life-sustaining procedures if you are in a state of permanent unconsciousness?
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 Enter an X if the Declarant also wants such procedures withdrawn or withheld if he or she is in a state of permanent unconsciousness.
{NEXT_?}
[The Declarant must initial one of the following on the printed document.]
If my condition is terminal and could result in death within a reasonably short time,
____ I direct that nutrition/hydration BE PROVIDED through any medically indicated means, including medically or surgically implanted tubes.
____ I direct that nutrition/hydration NOT BE PROVIDED through any medically indicated means, including medically or surgically implanted tubes.
LIW_SC03
{NEXT_?}
[The Declarant must initial one of these if life-sustaining procedures should be withheld or withdrawn if he or she is permanently unconscious.]
If I am in a persistent vegetative state, or other condition of permanent unconsciousness,
___ I direct that nutrition/hydration BE PROVIDED through any medically indicated means, including medically or surgically implanted tubes.
___ I direct that nutrition/hydration NOT BE PROVIDED through any medically indicated means, including medically or surgically implanted tubes.
LIW_SC04
{NEXT_?}
Yes, include the section.
LIW_SC04
PDo you wish to include information regarding artificial nutrition and hydration?
WSC04000
{NEXT_?}
In the absence of my ability to give directions regarding the use of life-sustaining procedures, it is my intention that this Declaration be honored by my family and physicians and any health facility in which I may be a patient as the final expression of my legal right to refuse medical or surgical treatment, and I accept the consequences from the refusal.
I am aware that this Declaration authorizes a physician to withhold or withdraw life-sustaining procedures. I am emotionally and mentally competent to make this Declaration.
This required section states how this document may be revoked. The Declarant must read this section on the printed document before signing the Living Will.
This is a required section in which the witnesses attest to being eligible as witnesses under the South Carolina Living Will statute. The Declarant and witnesses must read this section on the printed document before signing the Living Will.
LIW_SC12
{NEXT_?}
Name: |
Address 1: |
Address 2: |
City: |
State: |
Zip: |
[Include country]
Country: |
LIW_SC13
,What is the name and address of the witness?
{NEXT_?}
WSC13002
This is a required section in which a Notary Public acknowledges that the witnesses and the Declarant signed this document. The Notary must complete this section on the printed document at the time this Living Will is signed.
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