...Advance Directives, Continued
Important Notice: National Public Radio is providing sample documents
from the State of
Florida so that
you can familiarize yourself with the types of provisions and decision
making an individual faces
when executing a legal document of this sort. Requirements for these
directives, indeed the
laws governing the interpretation of these sorts of documents, vary from
State to State. You
should obtain advance directives specifically designed for use in your
State.
FLORIDA LIVING WILL
Declaration made this ____ day of ___________, 19 ____.
I,
______________S A
M P L E______________________,
willfully
and voluntarily make known my desire that my dying not be artificially
prolonged
under the circumstances set forth below, and I do hereby declare:
If at any time I have a terminal condition and if my attending or treating
physician and another consulting physician have determined that there is
no
medical probability of my recovery from such condition, I direct that
life-prolonging procedures be withheld or withdrawn when the application of
such
procedures would serve only to prolong artificially the process of dying,
and
that I be permitted to die naturally with only the administration of
medication or
the performance of any medical procedure deemed necessary to provide me
with comfort care or to alleviate pain.
It is my intention that this declaration be honored by my family and
physician as the final expression of my legal right to refuse medical or
surgical
treatment and to accept the consequences for such refusal.
In the event that I have been determined to be unable to provide express
and informed consent regarding the withholding, withdrawal, or
continuation of
life-prolonging procedures, I wish to designate, as my surrogate to carry
out
the provisions of this declaration:
Name: ____________________________________________________
Address: __________________________________________________
________________________________ Zip Code: _________
Phone: ___________________________________________________
I wish to designate the following person as my alternate surrogate, to
carry
out the provisions of this declaration should my surrogate be unwilling or
unable to act on my behalf:
Name: ____________________________________________________
Address: __________________________________________________
_____________________________ Zip Code: _________
Phone: ___________________________________________________
Additional instructions (optional):
I understand the full import of this declaration, and I am emotionally and
mentally competent to make this declaration.
Signed: ___________________________________________________
Witness 1:
Signed: ________________________________________________
Address: _______________________________________________
Witness 2:
Signed: ________________________________________________
Address: _______________________________________________
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