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Complete Home & Office Legal Guide
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Complete Home and Office Legal Guide (Chestnut) (1993).ISO
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1993-08-01
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34 lines
DECLARATION AS PROVIDED BY IOWA CODE 144A.3
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 freedom from pain.
Signed this _______________ day of _______________, 19_____
Signature:
________________________________________________________________
The declarant is known to me and voluntarily signed this
document in my presence.
Witness:
________________________________________________________________
Address:
Witness:
________________________________________________________________
Address: