DIRECTIVE TO PHYSICIANS AND FAMILY OR SURROGATES
Instructions for completing this document:
This is an important legal document known as an Advance Directive. It is designed to
help you communicate your wishes about medical treatment at some time in the
future when you are unable to make your wishes known because of illness or injury.
These wishes are usually based on personal values. In particular, you may want to
consider what burdens or hardships of treatment you would be willing to accept for a
particular amount of benefit obtained if you were seriously ill.
You are encouraged to discuss your values and wishes with your family or chosen
spokesperson, as well as your physician. Your physician, other health care provider,
or medical institution may provide you with various resources to assist you in
completing your advance directive. Brief definitions are listed below and may aid you
in your discussions and advance planning. Initial the treatment choices that best
reflect your person