GENERAL INSTRUCTIONS: Use this Living Will form to make decisions now about your medical care if you are ever
in a terminal condition, a persistent vegetative state or an irreversible coma. You should talk to your doctor about
what these terms mean. The Living Will states what choices you would have made for yourself if you were able to
communicate. It is your written directions to your health care representative if you have one, your family, your
physican, and any other person who might be in a position to make medical care decisions for you. Talk to your
family members, friends, and any others you trust about your choices. Also, it is a good idea to talk with professionals
such as your doctor, clergyperson and a lawyer before you complete and sign this Living Will.
If you decide this is the form you want to use, complete the form. Do not sign the Living Will until your witness
or a notary public is present to watch you sign it. There are further instructions for you about signing on page 2.
Information about me:
(I am called the "Principal")
My Date of Birth:
My decisions about End of Life Care:
NOTE: Here are some general statements about choices you have as to health care you want at the end of your life.
They are listed in the order provided by Arizona law. You can initial any combination of paragraphs A, B, C and D.
If you initial Paragraph E, do not initial any other paragraphs. Read all of the statements carefully before initialing
to indicate your choice. You can also write your own statement concerning life-sustaining treatments and other
matters relating to your health care at Section 3 of this form.
____A. Comfort Care Only:
If I have a terminal condition I do not want my life to be prolonged, and I do not want
life sustaining treatment, beyond comfort care, that would serve only to artificially delay the moment of my
death. (NOTE: "comfort care" means treatment in an attempt to protect and enhance the quality of life
without artificially prolongi