Life Sustaining Statute, New Mexico

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New Mexico Right to Die Act

DIRECTIONS OF ________________

I, _______________, of _______________, ________, __________, herewith state:

1. I am of sound mind and have reached the age of majority.

2. After due and mature deliberation I have decided that it is consistent with my religious, moral and ethical beliefs that if I should ever be certified under the New Mexico Right to Die Act as suffering from a terminal condition that “maintenance medical treatment” as is defined by that act shall not be utilized to prolong my life.

3. If the time comes when I, ________________, can no longer take part in decisions of my own future, let this statement stand as an expression of my wishes while I am still of sound mind.

4. This statement is made after careful consideration and is in accordance with my strong convictions and beliefs. I want the wishes and directions here expressed carried out to the extent permitted by law. Insofar as they are not legally enforceable, I hope that those to whom this will is addressed will regard themselves as morally bound by these provisions.

Signed: __________________________________________

Date: _________________

Witnesses:

________________________________________________________________

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