New Living Will Form

New Living Will Form (PG)

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I, __________________________, being of sound mind and body, do not wish to be kept alive indefinitely by artificial means. Under no circumstances should my fate be put in the hands of peckerwood politicians who couldn't pass ninth-grade biology if their lives depended on it.

If a reasonable amount of time passes and I fail to sit up and ask for:

(please initial all that apply)

_________a martini,

_________a margarita,

_________a beer,

__________a steak,

_________ the remote control,

__________ a bowl of ice cream,

_________ a Kalua on the rocks,

________ sex,

it should be presumed that I won't ever get better. When such a determination is reached, I hereby instruct my appointed person and attending physicians to pull the plug, reel in the tubes and call it a day.

Signature:___________________________

Date: ___________________________

Witness: __________________________

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