"Food and water are not medical treatment, but basic necessities. I direct my health care provider(s) and health care agent to provide me with food and fluids orally, intravenously, by tube, or by other means to the full extent necessary both to preserve my life and to assure me the optimal health possible.
"I direct that medication to alleviate my pain be provided, as long as the medication is not used in order to cause my death.
"I direct that the following be provided:
* the administration of medication;
* cardiopulmonary resuscitation (CPR); and
* the performance of all other medical procedures, techniques, and technologies, including surgery -- all to the full extent necessary to correct, reverse, or alleviate life-threatening or health-impairing conditions, or complications arising from those conditions.
"I also direct that I be provided basic nursing care and procedures to provide comfort care.
"I reject, however, any treatments that use an unborn or newborn child, or any tissue or organ of an unborn or newborn child, who has been subject to an induced abortion. This rejection does not apply to the use of tissues or organs obtained in the course of the removal of an ectopic pregnancy.
"I also reject any treatments that use an organ or tissue of another person obtained in a manner that causes, contributes to, or hastens that person's death.
"The instructions in this document are intended to be followed even if suicide is alleged to be attempted at some point after it is signed.
"I request and direct that medical treatment and care be provided to me to preserve my life without discrimination based on my age or physical or mental disability or the 'quality' of my life. I reject any action or omission that is intended to cause or hasten death.
"I direct my health care provider(s) and health care agent to follow the above policy, even if I am judged to be incompetent."
The NRLC document provides various suggestions for filling out the other sections for when death is imminent and for terminal illness.
For pregnancy, the form states:
"If I am pregnant, I direct my health care provider(s) and health care agent(s) to use all lifesaving procedures for myself with none of the above special conditions applying if there is a chance that prolonging my life might allow my child to be born alive. I also direct that lifesaving procedures be used even if I am legally determined to be brain dead if there is a change that doing so might allow my child to be born alive. Except as I specify ... no one is authorized to consent to any procedure for me that would result in the death of my unborn child."
The Christian Medical Association form, meanwhile, states under a section titled, "My Medical Treatment":
"I believe that life is very precious, a gift from God. I deserve to be treated with dignity and respect. If I cannot speak or decide for myself, I want the following requests carried out:
"-- All procedures directed by my physician should provide me with as much comfort and respect as possible.
"-- I want to be fed and hydrated by mouth if possible.
"-- I want to be kept warm and clean at all times.
"-- I do not want to be in pain. My doctor should give me medication to control my pain, regardless of whether that makes me drowsy or whether I sleep more than normal.
"-- If one or more physicians who have personally examined me reasonably believe that I am likely to die within 2 weeks as a result of a disease or illness despite receiving all appropriate medical treatment, then I want all burdensome procedures that would prolong the dying process to be withheld or withdrawn.
"-- I forbid any form of physician-assisted suicide, euthanasia or any other action done with the intent of ending my life.
"-- I want to be given food and fluids as long as I can swallow. If I am unable to swallow:
"(initial one)
