Advance Medical Directive: Sample Form
Medical Author: Maude B. Hecht, RN
The current case of Terri Schiavo has focussed the spotlight on the issue of advance medical directives. An advance directive, through a living will or the designation of a health care proxy, prevents the involvement of the courts "in virtually all cases," according to George J. Annas, J.D., M.P.H writing in an article published online by The New England Journal of Medicine on March 22, 2005.
Here is an example of an Advance Medical Directive. It is a real one. It happens to have been prepared (and signed) by a 36-year-old woman who lives in the State of Texas. Points 1-6 (below) are, as required, in accord with the Texas Health Code. Point 7 was added to specify further her wishes.
Remember that this is just an example. Your Advance Medical Directive should reflect your own personal wishes.
Directive to Physicians
Directive made this __th day of ____ in the year ____.
I,_____, being of sound mind, willfully and voluntarily make known my desire that my life shall not be artificially prolonged under the circumstances set forth in this directive.
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