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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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LIVING WILL AS PROVIDED BY TENNESSEE CODE 32-11-105
LIVING WILL OF ___________________
I, ____________, willfully and voluntarily make known my desires
that my dying shall not be artificially prolonged under the
circumstances set forth below, and do hereby declare:
If at any time I should have a terminal condition and my
attending physician has determined that there can be no recovery
from such condition and my death is imminent, and where the
application of life-prolonging procedures would serve only to
artificially prolong the dying process, I direct that such
procedures be withheld or withdrawn, and that I be permitted to
die naturally with only the administration of medications or the
performance of any medical procedure deemed necessary to provide
me with comfort care or to alleviate pain.
In the absence of my ability to give directions regarding the use
of such life-sustaining procedures, it is my intention that this
declaration 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.
I understand the full import of this declaration and I am
emotionally and mentally competent to make this declaration. In
acknowledgement whereof, I do hereinafter
affix my signature on this the ___________ day of ______________
19___________.
_____________________________________________________________
Declarant- ________________
Residing at : _____________
___________________________
We, the subscribing witnesses hereto, are personally acquainted
with and subscribe our names hereto at the request of the
declarant, an adult, whom we believe to be of sound mind, fully
aware of the action taken herein and its possible consequence. We,
the undersigned witnesses, further declare that we are not related
to the declarant by blood or marriage; that we are not entitled to
any portion of the estate of the declarant upon his decease under
any will or codicil thereto presently existing or by operation of
law then existing; that we are not the attending physician, an
employee of the attending physician or a health facility in which
the declarant is a patient; and that we are not a person who, at
the present time, has a claim against any portion of the estate of
the declarant upon his death.
Witness ______________________________________________
Witness _______________________________________________
Subscribed, sworn to and acknowledged before me by ____________,
the declarant, and subscribed to before me
by __________________________ and _____________________________,
witnesses, this _______ day of ___________________________ 19___.
_______________________________________________________________
Notary Public