State Of Arizona living Will End Of Life Care Instructions And Form1

azaggov, Feb 24, 2005

Information about me: (I am called the “Principal”)My Name:My Age:My Address: My Date of Birth:My Telephone:___________________ ____2.My decisions about End of Life Care:A. Comfort Care Only:

If I have a terminal condition I do not want my life to be prolonged, and I do not wantlife-sustaining treatment, beyond comfort care, that would serve only to artificially delay the moment of mydeath.

(NOTE: “Comfort care” means treatment in an attempt to protect and enhance the quality of lifewithout artificially prolonging life.)B. Specific Limitations on Medical Treatments I Want: (NOTE: Initial or mark one or more choices, talk toyour doctor about your choices.)

If I have a terminal condition, or am in an irreversible coma or a persistentvegetative state that my doctors reasonably believe to be irreversible or incurable, I do want the medicaltreatment necessary to provide care that would keep me comfortable, but I do not want the following:1.)

Cardiopulmonary resuscitation, for example, the use of drugs, electric shock, and artificialbreathing.2.)

Artificially administered food and fluids.3.)

To be taken to a hospital if it is at all avoidable.C. Pregnancy: Regardless of any other directions I have given in this Living Will, if I am known to be pregnantI do not want life-sustaining treatment withheld or withdrawn if it is possible that the embryo/fetus willdevelop to the point of live birth with the continued application of life-sustaining treatment.D.

Treatment Until My Medical Condition is Reasonably Known: Regardless of the directions I have madein this Living Will, I do want the use of all medical care necessary to treat my condition until my doctorsreasonably conclude that my condition is terminal or is irreversible and incurable, or I am in a persistentvegetative state.E.

Direction to Prolong My Life: I want my life to be prolonged to the greatest extent possible