home
***
CD-ROM
|
disk
|
FTP
|
other
***
search
/
Complete Home & Office Legal Guide
/
Complete Home and Office Legal Guide (Chestnut) (1993).ISO
/
ex
/
fib
/
pe
/
5000.fib
< prev
next >
Wrap
Text File
|
1993-08-01
|
2KB
|
64 lines
DECLARATION AS PROVIDED BY ALASKA STATUES, SEC 18.12.010
DECLARATION of ______________
If I should have an incurable or irreversible condition that
will cause my death within a relatively short time, it is my
desire that my life not be prolonged by administration of life-
sustaining procedures.
If my condition is terminal and 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 to
alleviate pain.
I do [ ] do not [ ] desire that nutrition or hydration (food
and water) be provided by gastric tube or intravenously if
necessary.
Signed this______ day of _____________________, 19______________
Signature:
________________________________________________________________
Place of signing: _____________________
The declarant is known to me and voluntarily signed or
voluntarily directed another to sign this document in my
presence
Witness:
________________________________________________________________
Signature
Address:
________________________________________________________________
Signature
Address:
State of _________________________
__________________________________ Judicial District
The foregoing instrument was acknowledged before me this
________________________________________, 19_________________ by
___________________.
_________________________________________
Signature of person taking acknowledgment