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Life Support Directive

In the absence of my expressed instructions, I, hereby, indicate that I wish all life-saving, life-sustaining and/or life-prolonging measures to be used to preserve my life, regardless of condition, dependency, prognosis, or any other factor, including a terminal condition or the absence of brain activity in whole or part. Under no circumstance is any other party authorized to deny or withdraw any such measure, thereby, ending or shortening by act or omission my life span. My life span is determined by God and must not be shortened by me or others. I appreciate and reverence God's gift of life under any and all circumstances and express my heartfelt gratitude towards all who shall help me preserve and protect that sacred gift. I request that this directive be entered into my hospital record as testimony to my instructions and desires.

 

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patient

 

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date

 

_________________________________________________________

witness

 

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witness

 

 


Instructions

Every family physician should have a Life Support Directive on file for each family member he cares for, witnessed by himself. Keep one Directive with your important family papers. Another should be kept on your person (billfold, car glove box, etc.). You may wish to complete additional Directives to provide CURE and your attorney.

A new Life Support Directive should be completed at the initial meeting with the attending physician on each occasion of hospitalization. Ideally, the witnesses should be hospital personnel, including the attending physician, who should be informed of the Directive as soon as possible. (If the patient is unable to sign the Directive, a legal guardian or family member should sign on his or her behalf.)

At least two Life Support Directives should be completed. The hospital should be instructed to place its copy in a prominent place in the patient's chart. The patient's copy should be kept by the family in a safe place. You may also file copies with CURE and your attorney.

At the time of admission, the patient (or his or her representative) should enter the following language on the admission form immediately prior to signature: "As per Life Support Directive, to be entered in my hospital records."

Physicians who respect the rights of patients to choose medical treatment to preserve their lives should have no difficulty with witnessing and honoring the Life Support Directive. In more than a decade of its use, CURE has found that even physicians who do not share our pro-life philosophy can accept the Life Support Directive if they do not insist on imposing their anti-life, "quality-of-life" values on their patients.

If your physician (or hospital) has any problems with witnessing or honoring the Life Support Directive, you should change doctors (or hospitals), if at all practical. (This is essential in the case of a family physician.)

A doctor whose idea of patient rights favors your "right to die" but denies your Right to Life is dangerous to your health, and may prove deadly. A hospital that honors "Living Wills" but not Life Support Directives is a hospice disguised as a medical treatment facility and not the best place for one who wishes to live.

Please contact CURE if we may help you or your loved ones in any way, at any time, with these or other matters of concern. Our phone is answered 24 hours a day, 7 days a week.

God bless and keep you and yours always in His unfailing care. (Please duplicate and share this Directive with your family and friends.)

Where There's Life, There's Hope