My living will

I realize this probably won’t hold up in court, but it still serves as a public declaration to everyone who knows me that I don’t want to be kept on life support when it makes no sense to do so. The moral here: If in doubt, pull the plug. This crap in Florida really freaked me out. This should leave no doubt of my wishes …

ADVANCE HEALTH CARE DIRECTIVE

I, Robert John Benz, being of sound mind and at least 18 years of age, declare that:

(1) END-OF-LIFE DECISIONS: I direct that my health care providers and others involved in my care provide, withhold, or withdraw treatment in accordance with the choice I have marked below: (Initial only one box)

* [X] (a) Choice NOT To Prolong Life. I do not want my life to be prolonged if (1) I have an incurable and irreversible condition that will result in my death within a relatively short time, (2) I become unconscious and, to a reasonable degree of medical certainty, I will not regain consciousness, or (3) the likely risks and burdens of treatment would outweigh the expected benefits, OR
* [___] (b) Choice To Prolong Life. I want my life to be prolonged as long as possible within the limits of generally accepted health care standards.

(2) RELIEF FROM PAIN: Except as I state in the following space, I direct that treatment for alleviation of pain or discomfort should be provided at all times even if it hastens my death:
____________________________________________________________________ _______________________________________________________________________ _______________________________________________________________________.

(3) OTHER WISHES: (If you do not agree with any of the optional choices above and wish to write your own, or if you wish to add to the instructions you have given above, you may do so here.) I direct that:
Not applicable_______________________________________________________________________ _______________________________________________________________________ _______________________________________________________________________

(4) PRIMARY PHYSICIAN -(OPTIONAL).

* I designate the following physician as my primary physician:
_________________________________
(name of physician)

_______________________________________________________________________
(address) (city) (state) (zip code)

_________________________________
(phone)

OPTIONAL: If the physician I have designated above is not willing, able, or reasonably available to act as my primary physician, I designate the following physician as my primary physician:
* _________________________________
(name of physician)

_______________________________________________________________________
(address) (city) (state) (zip code)

_________________________________
(phone)

(5) DONATION OF ORGANS AT DEATH – (OPTIONAL).

Notwithstanding my previous declaration relative to the withholding or withdrawal of life-prolonging procedures, if as indicated below I have expressed my desire to donate my organs and/or tissues for transplantation, or any of them as specifically designated herein, I do direct my attending physician, if I have been determined dead according to Tennessee Code Annotated, Section 68-3-501 (b), to maintain me on artificial support systems only for the period of time required to maintain the viability of and to remove such organs and/or tissues.

* [X] (a) I give any needed organs, tissues, or parts, OR
* [___] (b) I give the following organs, tissues, or parts only.

* [X] (c) My gift is for the following purposes: (strike any of the following you do not want)
o (1) Transplant
o (2) Therapy
o (3) Research
o (4) Education

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

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

I execute this declaration, as my free and voluntary act, on this 26 day of March, 2005, in the City of Knoxville, County of Knox, State of Tennessee.

/s/______________________________________
Robert John Benz