DISTRICTOFCOLUMBIADECLARATION

DISTRICT OF COLUMBIA DECLARATION

Declaration made this _____ day of __________, 19__ (month, year).

I____________________, being of sound mind, willfully and voluntarily make known my desires that my dying shall not be artificially prolonged under the circumstances set forth below, do declare :

If at any time I should have an incurable injury, disease, or illness certified to be a terminal condition by 2 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 lifesustaining
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중략
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I am at least 18 years of age and am not related to the declarant by blood or marriage, entitled to any portion of the estate of the declarant according to the laws of intestate succession of the District of Columbia or under any will of the declarant or codicil thereto, or directly financially responsible for declarant's medical care. I am not the declarant's attending physician, an employee of the attending physician, or an employee of the health facility in which the declarant is a patient.

Witness: ____________________________________
Witness: ____________________________________

[hwp/doc/pdf]DISTRICTOFCOLUMBIADECLARATION