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_TX04
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_TX04
}Should pain or physical harm be considered in determining whether life-sustaining procedures should be withheld or withdrawn?
{NEXT_?}
Yes, include the section.
LIW_TX04
LDo you wish to state the effectiveness of this document if you are pregnant?
LAL04002
{NEXT_?}
Other requests:#|
LIW_TX05
^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_TX07
3Do you wish to include this severability provision?
{NEXT_?}
YesNo
LIW_TX03
HDo you wish to receive artificially administered nutrition or 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 if there is no hope of recovery from your condition.
{NEXT_?}
Yes, include the paragraph.
LIW_TX03
PDo you wish to include information regarding artificial nutrition and hydration?
LDE03002
{NEXT_?}
Name: |
LIW_TX01
+Who is this Living Will being prepared for?
{NEXT_?}
Yes, procedures should be withheld or withdrawn.
LIW_TX02
Is it your desire that your life NOT be prolonged by life sustaining procedures if two physicians have determined that you are in a permanently unconscious condition?
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 Enter an X if the Declarant also wants such procedures withdrawn or withheld if he or she is permanently unconscious.
Enter the Proxy's name or use the P.I. Manager to select and paste a record. A "proxy" is someone you designate to make health care decisions for you if you are unable to do so. Press [Ctrl+F1] for more information.
In the absence of my ability to give directions regarding the use of those life-sustaining procedures, it is my intention that this directive shall be honored by my family and physicians as the final expression of my legal right to refuse medical or surgical treatment and accept the consequences from such refusal.
This directive is in effect until it is revoked. I understand the full import of this directive and I am emotionally and mentally competent to make this directive. I understand that I may revoke this directive at any time.
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