*** DIRECT.TXT ******************************* *** C A U T I O N *** ******************************* Do Not Use These Documents Without Consulting An Estate Planning Attorney. The purpose of this software product is to assist you in the preparation of sample estate planning documents. You must have these documents reviewed and approved by an Estate Planning Attorney to ensure that the documents meet your particular needs, as well as to ensure that the documents conform to requirements of state and federal laws. JIAN and the authors of the software do not represent or guarantee that these documents are appropriate for your needs, satisfy any provision of state or federal law or will have any particular state or federal tax effect. ---------------------------------------------------------------------- REMEMBER to change the complete insertion code (***Q1***, ***Q2***, etc.) and not just the "Q1" or "Q2". This document references the following insertion codes: (None) ********************************************************************** Directive To Physician (Living Will) This document, sometimes called a "Living Will," describes your desires regarding life support and, while the document may not be legally binding, confirms the elections made in the Durable Power Of Attorney For Health Care. This document expires at the end of five years. This Document Must Be Reviewed By An Estate Planning Attorney Before You Sign It. ********************************************************************** DIRECTIVE TO PHYSICIAN DIRECTIVE made this _____ day of ____________, 19___. 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 below, and do hereby declare: 1. If at any time I should have an incurable injury, disease, or illness certified to be a terminal condition by two (2) physicians, and where the application of life-sustaining procedures would serve only to artificially prolong the moment of my death and where my physician determines that my death is imminent whether or not life-sustaining procedures are utilized, I direct that such procedures be withheld or withdrawn, and that I be permitted to die naturally. 2. In the absence of my ability to give directions regarding the use of such life-sustaining procedures, it is my intention that this Directive shall be honored by my family and physician(s) as the final expression of my legal right to refuse medical or surgical treatment and accept the consequences of such refusal. 3. If I have been diagnosed as pregnant and that diagnosis is known to my physician, this Directive shall have no force or effect during the course of my pregnancy. 4. I have been diagnosed and notified at least fourteen (14) days ago as having a terminal condition by ________________, M.D., whose address is __________________________________________________ and whose telephone number is ______________. I understand that if I have not filled in the physician's name and address, it shall be presumed that I did not have a terminal condition when I made this Directive; 5. This Directive shall have no force or effect five (5) years from the date filled in above. 6. I understand the full import of this Directive and I am emotionally and mentally competent to make this Directive. Signed _______________________________ STATEMENT OF WITNESSES The Declarant has been personally known to me and I believe Declarant to be of sound mind. Signature: __________________________________ Print Name: __________________________________ Address: __________________________________ __________________________________ Signature: __________________________________ Print Name: __________________________________ Address: __________________________________ __________________________________