FLORIDADECLARATION

FLORIDA DECLARATION

Declaration made this _____ day of __________, 19__.I, ____________________, willfully and voluntarily make known my desire that my dying not be artificially prolonged under the circumstances set forth below, and I do hereby declare:

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In the absence of my ability to give directions regarding the use of such life-prolonging procedures, it is my intention that this declaration be honored by my family and physician as the final expression of my legal right to refuse medical or surgical treatment and accept the consequences for such refusal.

If I have been diagnosed as pregnant and that diagnosis is known to my physician, this declaration shall have no force or effect during the course of my pregnancy.

I understand the full import of this declaration, and I am emotionally and mentally competent to make this declaration.

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(Signed)

The declarant is known to me, and I believe him or her to be of sound mind.

_______________________
Witness
_______________________
Witness

[hwp/doc/pdf]FLORIDADECLARATION