Page 1 of 1

Be prepared as the Guides apparently say...

PostPosted: Mon May 05, 2014 5:56 pm
by Judith
Advance Directive

Here is a document you can fill in and sign (in the presence of a witness) and keep safe somewhere maybe alongside your will which is also advisable to have up to date of course -this Advanced Directive was passed on to me by an old lady now no longer on the planet (and who left it the way she wanted to thanks to this document )-and I thank her for this--give it to your nearest and dearest who will pull it out when the time comes, to show to anyone interested in prologing your life in a way that you do not want. Handy to have- I've had mine for years, ever since she gave it to me.

My-choice-My-voice.jpg
My-choice-My-voice.jpg (13.87 KiB) Viewed 4029 times


This Advance Directive is made by me, (name and address)

I was born on (--), and I make this Advance Directive at a time when I am of sound mind and after careful consideration and not under the influence of any third party.

I intend this Advance Directive to take effect if I am in a state when I am no longer capable of making or communicating any decision regarding my medical treatment and if I am suffering from one of the conditions set out below in which I am likely to spend the remainder of my life.

If I am in a persistent vegetative state.

If I have been in a coma for some time.

If following a stroke (or from any other cause) I would be or be likely to become seriously mentally incapacitated not withstanding treatment

I hereby direct that in such circumstances -

1 I refuse any medical or surgical treatment which is aimed at prolonging or sustaining my life.

2 I consent to receive treatment which will relieve any pain or suffering and make me more comfortable and to being fed. I consent to such treatment even though it may shorten my life.

3 If I am unable to make or communicate a medical treatment decision I would like my Doctor ( )- to be consulted before any decision about treatment is made.


SIGNED by me:
in the presence of:

Witness:

Signature:


Name