A LIVING WILL

                  A directive to withhold treatment and for
                  the administration of pain-killing drugs


To my family, my relatives, my physicians, my employers, and all others whom
it may concern:

I, (name), of (address), City of (city), County of (county), State of
(state), being of sound mind, willfully, and voluntarily make known my desire
that my life shall not be prolonged artificially under the circumstances set
forth below, do hereby declare:

1. If, at any time, I should have an incurable injury, disease, illness, or
condition certified to be terminal by two medical doctors who have examined
me, and where the application of life-sustaining procedures of any kind would
serve only to prolong artificially the moment of my death, and where a
medical doctor 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or withdrawn and that I be permitted to die naturally, and that I receive
whatever quantity of whatever drugs may be required to keep me free of pain
or distress even if the moment of death is hastened.

2. In the absence of my ability to give directions regarding the use of life-
sustaining procedures, I hereby appoint (name) of (address), City of (city),
County of (county), State of (state), as my attorney-in-fact/proxy for the
purpose of making decisions relating to my health care in my place; and it
is my intention that this appointment shall be honored by him/her, by my
family, relatives, friends, physicians, and lawyer as the final expression
of my legal right to refuse medical or surgical treatment; and I willfully
accept the consequences of such a decision.  I have duly executed a Durable
Power of Attorney for health care on this date.

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Under California law, for such an appointment to be as fully effective as
the law will permit, it must be in the form included under the title "DURABLE
POWER OF ATTORNEY FOR HEALTH CARE CONDITIONS."  Persons living in other
states and executing this "Living Will" also might wish to execute that same
Durable Power of Attorney form, since it might be honored by the courts of
any particular state.
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3. In the absence of my ability to give further directions regarding my
treatment, including life-sustaining procedures, it is my willful intention
that this directive shall be honored by my family and physicians as the final
expression of my legal right to refuse or accept medical or surgical
treatment, and I fully and willfully accept the consequences of such refusal.

4. If I have been diagnosed as pregnant and that diagnosis is known to any
interested person, this directive shall have no force during the course of
my pregnancy.

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Males should strike out this paragraph entirely.
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5. I have been diagnosed, and notified at least 14 days ago, as being in a
terminal condition by (physician's name), M.D., of (address), City of (city),
State of (state).  It is my intention 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 completed this directive.

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If you are not a resident of California, strike out this paragraph entirely.
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6.  I fully and completely understand the full importance of this directive
and am emotionally and mentally competent to make this directive.  No
participant in the making of this directive or on its being carried into
effect, whether it be a medical doctor, my spouse, a relative, friend, or any
other person shall be held responsible in any way, legally, professionally
or socially, for complying with my directions.

In Witness Whereof, I have executed this directive on the date entered below.


_________________________
(Name)                        


_________________________     _________________________
Witness 1                     Witness 2


Sworn to and subscribed before me this (day) day of (month), 19(year).


My commission expires:          _________________________
                                Notary Public

_________________________
Date