I, _________________________ (fill in the blank), being of sound mind and body, unequivocally declare that in the event of a catastrophic injury, I do not wish to be kept alive indefinitely by artificial means. I hereby instruct my loved ones and relatives to remove all life-support systems, once it has been determined that my brain is longer functioning in a cognizant realm. However, that judgment should be made only after thorough consultation with medical experts; i.e., individuals who actually have been trained, educated and certified as doctors.
Under no circumstances — and I can’t state this too strongly — should my fate be put in the hands of peckerwood politicians who couldn’t pass ninth-grade biology if their lives depended on it. Furthermore, it is my firm hope that, when the time comes, any discussion about terminating my medical treatment should remain private and confidential.
Therefore, I wish to make my views on this subject as clear and unambiguous as possible. Recognizing that some politicians seem cerebrally challenged themselves (and with no medical excuse), I’ll try to keep this simple and to the point:
1. While remaining sensitive to the feelings of loved ones who might cling to hope for my recovery, let me state that if a reasonable amount of time passes — say, ____ (fill in the blank) months — and I fail to sit sit up and ask for a cold beer, it should be presumed that I won’t ever get better. When such a determination is reached, I hereby instruct my spouse, children and attending physicians to pull the plug, reel in the tubes and call it a day.
2. Under no circumstances shall the members of the Legislature enact a special law to keep me on life-support machinery. It is my wish that these boneheads mind their own damn business, and pay attention instead to the health, education and future of the millions of Americans who aren’t in a permanent coma.
3. Under no circumstances shall any politicians butt into this case. I don’t care how many fundamentalist votes they’re trying to scrounge for their run for the presidency, it is my wish that they play politics with someone else’s life and leave me alone to die in peace.
4. I couldn’t care less if a hundred religious zealots send e-mails to legislators in which they pretend to care about me. I don’t know these people, and I certainly haven’t authorized them to preach and crusade on my behalf. They should mind their own business, too.
5. It is my heartfelt wish to expire quietly and without a public spectacle. This is obviously impossible once elected officials become involved. So, while recognizing the wrenching emotions that attend the prolonged death of a loved one, I hereby instruct my relatives to settle all disagreements about my care in private or in the courts, as provided by law. If any of my family goes against my wishes and turns my case into a political cause, I hereby promise to come back from the grave and make his or her existence a living ____ (fill in the blank)
I found this on: http://blog.bioethics.net/2005/03/new-living-will-form.html