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1993-01-06
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#5570
@001 Please state the name of the declarant:
#end control section
#5570
/* Maine living will */
DECLARATION PROVIDED BY MAINE REVISED STATUTES
TITLE 22 SECTION 2922
DECLARATION
If I should have an incurable or irreversible condition
that will cause my death within a short time, and if I am unable
to participate in decisions regarding my medical treatment, I
direct my attending physician to withhold or withdraw procedures
that merely prolong the dying process and are not necessary to
my comfort or freedom from pain.
Signed this _____________ day of _______________________________
date month year
Signature ______________________________________________
@001
The declarant is known to me and voluntarily signed this document
in my presence.
Witness ________________________________________________
Address:
Witness ________________________________________________
Address: