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{\title  }{\author Bernard Hamill}{\operator Preferred Customer}{\creatim\yr2002\mo1\dy28\hr14\min39}{\revtim\yr2005\mo4\dy6\hr18\min48}{\version3}{\edmins5}{\nofpages2}{\nofwords526}{\nofchars3003}{\*\company Dell Computer Corporation}{\nofcharsws3522}
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\fs20\insrsid5981147  }{\insrsid5981147\charrsid5981147 
\par  
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\par }\pard \qc \li0\ri0\widctlpar\faauto\rin0\lin0\itap0 {\b\ul\insrsid5981147\charrsid5981147 LIVING WILL}{\insrsid5981147\charrsid5981147 
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\par }{\b\insrsid5981147\charrsid5981147 TO:}{\insrsid5981147\charrsid5981147   My family, physicians and all 
\par      those concerned with my care
\par 
\par \tab \tab }{\insrsid5981147 I, \tab \tab \tab     }{\insrsid5981147\charrsid5981147 presently residing at________}{\insrsid5981147 _________,}{\insrsid5981147\charrsid5981147 
________, and being an adult of sound mind, make this declaration as a directive to be followed if for any reason I become unable to make or communicate decisions regarding my medical care.  
\par 
\par \tab \tab I do not want medical treatment that will keep me alive if I am unconscious and there is no reasonable prospect that I will ever be conscious again (even if I am not going to die soon in my medical condition) }{
\ul\insrsid5981147\charrsid5981147 or}{\insrsid5981147\charrsid5981147  if I am near death from an illness or injury with no reasonable prospect of recovery.  The procedures and treatment to be withheld and withdrawn include, without limi\-
tation, surgery, antibiotics, cardiac and pulmonary resuscita\-tion, respiratory support, and artificially administered feeding and fluids.  I dire
ct that treatment be limited to measures to keep me comfortable and to relieve pain, even if such measures shorten my life.  
\par 
\par \tab [OPTIONAL]\tab I wish to live out my last days at home rather than in a hospital, if it does not jeopardize the chance of my recovery to a meaningful and conscious life and does not impose an undue burden on my family.  
\par 
\par \tab [OPTIONAL]\tab If, upon my death, any of my tissue or organs would be of value for transplantation, therapy, advancement of medical or dental science, research, or other medical, educational or scien\-
tific purpose, I freely give my permission to the donation of such tissue or organs.  
\par 
\par \tab \tab These directions are the exercise of my legal right to refuse treatment.  Therefore, I expect my family, physicians, health care facili
ties and all concerned with my care to regard themselves as legally and morally bound to act in accordance with my wishes, and in so doing to be free from any liability for having followed my directions.  
\par 
\par \tab \tab }{\b\insrsid5981147\charrsid5981147 IN WITNESS WHEREOF}{\insrsid5981147\charrsid5981147 , I have executed this declaration, as my free and voluntary act and deed,}{\insrsid5981147\charrsid5981147  this ____day of _________, 2005}{
\insrsid5981147\charrsid5981147 .
\par 
\par }\pard \ql \li3840\ri0\widctlpar\faauto\rin0\lin3840\itap0 {\insrsid5981147\charrsid5981147 
\par __________________________
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\par WITNESS:
\par 
\par \tab \tab We}{\insrsid5981147 , the undersigned witnesses}{\insrsid5981147\charrsid5981147 , each hereby attest and declare under penalty of perjury under the laws of the Common\-
wealth of Massachusetts that:  (1) the foregoing instrument was personally signed by }{\insrsid5981147 \tab \tab \tab }{\insrsid5981147\charrsid5981147 
 in my presence, and thereupon I, at his request and in his/her presence and in the presence of the other witnesses, have hereunto subscribed my name as a witness; (2) I did not sign the above signature of (YOUR NAME) for or at his/her dir
ection; (3) I personally know (YOUR NAME) and believe him/her to be of sound mind and under no constraint, duress, fraud or undue in\-
fluence; (4) I am not related to (YOUR NAME) by blood, marriage or adoption; (5) I am not entitled (to the best of my knowl
edge and belief) to any portion of the estate of (YOUR NAME) upon his/her death under any will or codicil of (YOUR NAME) or by operation of law; (6) I do not have any present or inchoate claim against any por\-
tion of the estate of (YOUR NAME); (7) I do not have any financial responsibility for the medical care of (YOUR NAME); (8) I am not a physician or an employee of any physician, and I am not an oper\-
ator or employee of, or patient in, any hospital, health care provider, residential care facility, community care facility or similar institution; and (9) I am at least 18 years of age.
\par 
\par }{\insrsid5981147\charrsid5981147 Dated:  _________, 2005}{\insrsid5981147\charrsid5981147 
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\par 
\par __________________________
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\par residing at 
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\par __________________________
\par 
\par __________________________
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\par 
\par __________________________
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\par residing at 
\par }\pard \ql \li4800\ri0\widctlpar\faauto\rin0\lin4800\itap0 {\insrsid5981147\charrsid5981147 
\par __________________________
\par 
\par __________________________
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