LIVING WILL Directive made this 1st day of March, 1995. TO MY FAMILY, MY PHYSICIAN, MY CLERGYMAN, MY LAWYER: I, John Smith, being of sound mind, willfully and voluntarily make known my desire that my life shall not be artificially prolonged pursuant to the following: If the time comes when I can no longer take part in decisions for my own future, this statement and declaration shall stand as the expression of my wishes. I recognize that death is as much a reality as birth, growth, maturity, and old age - it is but a phase in the cycle of life and is the only certainty. I do not fear death as much as I fear the indignity of deterioration, dependence, and hopeless pain. If there is no reasonable expectation of my recovery from physical or mental disability, I wish to be allowed to die and not be kept alive by artificial means or heroic measures, but wish only that drugs be mercifully administered to me for terminal suffering, even if they hasten the moment of my death. I recognize that my wishes place a heavy burden of responsibility upon you, and I therefore make the following declaration with the intention of sharing this responsibility and the decision with you and of mitigating any feelings of guilt that you may have: DECLARATION If at any time I should have an incurable injury, disease, or illness certified to be a terminal condition by two physicians, and where the application of life-sustaining procedures would serve only to artificially prolong the moment of my death and where any physician determines that my death is imminent whether or not life-sustaining procedures are utilized, I direct that such procedures be withheld or withdrawn, and that I be permitted to die naturally. In the absence of my ability to give directions regarding the use of such life-sustaining procedures, it is my intention that this directive shall be honored by my family and physicians as the final expression of my legal right to refuse medical or surgical treatment and accept the consequences from such refusal. I have not been diagnosed as having a terminal condition when I made out this directive. Page 1 I understand the full import of this directive and I am emotionally and mentally competent to make this directive. ________________________ John Smith City or Town and State or Territory of Residence: Orange, USA. The declarant has been personally known to me and I believe John Smith to be of sound mind. ___________________________ ___________________________ Page 2