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SAMPLE LANGUAGE FOR HEALTH CARE DIRECTIVES

SAMPLE LANGUAGE FOR HEALTH care DIRECTIVES ESTATE & ELDER LAW SERVICES 1900 Central Ave NE, Suite 106 Minneapolis, MN 55418 612-676-6300 Monica Lewis, Attorney at Law Lori D. Skibbie, Attorney at Law SAMPLE LANGUAGE for HEALTH care DIRECTIVES A. My General View Regarding My HEALTH care I have lived a good, long life. I am not afraid to die. If I am near death, I do not want any treatments or procedures that will only prolong my life rather than make it better Any decision about my care should be based on the quality of life it is likely to preserve.

Ventilator/Respirator • Life would not be worth living if I had to be kept on a respirator indefinitely. • I have no objection to the temporary use of a respirator or ventilator to keep me alive until I resume breathing on my own. • If I am close to death, I do not want to be put on a respirator or ventilator for any reason. If such

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