viernes, 21 de agosto de 2009

Life Sustaining Statute, Arizona

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Statutory Declaration in Conformance with Arizona Medical Treatment Decision Act, AZ. REV. STAT. 36-3202

DECLARATION OF __________________

Declaration made this __________ day of ________________ 20________. I, ______________, being of sound mind, willfully and artificially prolonged under the circumstances set forth below and declare that:

If at any time I should have an incurable injury, disease, or illness certified to be a terminal condition by two physicians who have personally examined me, one of whom is my attending physician, and the physicians have determined that my death will occur unless life-sustaining procedures are used and if the application of life-sustaining procedures would serve only to artificially prolong the dying process, I direct that such procedures be withheld or withdrawn, and that I be permitted to die naturally with only the administration of medication, food or fluids or the performance of any medical procedures deemed necessary to provide me with comfort care.

In the absence of my ability to give directions regarding the use of such life-sustaining procedures, it is my intention that this declaration shall be honored by my family and physicians as the final expression of my legal right to refuse medical or surgical treatment and accept the consequences from such refusal.

I understand the full import of this declaration and I have the emotionally and mental capacity to make this declaration.

________________________________________

City of residence: _____________

County of residence: ___________

State of residence: ____________

Date: ________________________________

The Declarant has been personally known to me and I believe him or her to be of sound mind.

Witness _________________________________________________

Witness _________________________________________________

Date: _________________________


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