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LIVING WILL DECLARATION
Kansas Natural Death Act
I, _________________________________, being
of sound mind, willfully and voluntarily making
known my desire that my dying shall not be
artificially prolonged under the circumstances set
forth below, do hereby declare:
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 shall be my attending physician, and the
physicians have determined that my death will occur
whether or not life-sustaining procedures are utilized
and where the application of life-sustaining procedures
would serve only to artificially prolong the dying
process, I direct that such procedures be withheld or

Declarations made this

withdrawn and that I be permitted to die naturally
with only the administration of medication or the
performance of any
medical procedure deemed necessary to provide
me with comfort care.
In the absence of my ability to give dire