Free living will template 37
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I, ____________________________________________________, direct those involved in my
healthcare to implement my healthcare preferences, as indicated below, when I cannot speak for
myself. My medical power of attorney is_______________________ and I expect that he/she
will honor my wishes as stated below.
_____ I want my life to be prolonged to the greatest extent possible, i.e. with use of all
available artificial life-sustaining treatments.
If you initial this statement, do not initial any others on this page and proceed to signing
the document.
_____ I expect my doctor to administer treatments that may help me enjoy an acceptable
quality of life. However, if my quality of life becomes unacceptable to me, I direct that
treatments be withdrawn. My healthcare power of attorney will decide what an acceptable
quality of life is for me when I can no longer speak for myself.
I always expect to be given care and treatment for pain and symptom control even when such care