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South Dakota Advanced Health Care Directive - Living Will and Health Care Proxy

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South Dakota Advanced Health Care Directive - Living Will and Health Care Proxy Powered By Docstoc
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                             This Advanced Health Care Directive (Living Will and Health Care Proxy) is intended to be
                             used by an individual located in South Dakota to express his or her directions regarding
                             whether or not life-sustaining procedures are to be utilized in the event of the individual's
                             incapacity. The directive provides for the appointment of a Health Care Proxy in case the
                             individual is unable to speak for him or herself due to terminal illness, injury, or permanent
                             unconsciousness. This document contains both standard provisions commonly found in
                             advanced health care directives and opportunities for customization to address the specific
                             directions of the individual.
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                         ADVANCED HEALTH CARE DIRECTIVE

                              (Living Will and Health Care Proxy)

1. LIVING WILL

   I, ________________ [Instruction: Insert the name of person making the direction],
   being of sound mind, would like to make and express the following wishes known. I direct
   that my family, my doctors and health care workers, and all others follow such directions I
   am writing down in this document. I know that at any time I can change my mind about these
   directions by tearing up this form and writing a new one. I can also do away with these
   directions by tearing them up and by telling some adult person of my wishes and asking him/
   her to write them down as per my instructions.

   I understand that these directions will only be used in case I am not being able to speak for
   myself.

   a. If I become terminally ill or injured

       Terminally ill or injured is when my doctor and another doctor decide that I have a
       condition that cannot be cured and that I will likely die in the near future from this
       condition.

        i. Life sustaining treatment.

           Life sustaining treatment includes drugs, machines, or medical procedures that would
           keep me alive, but would not cure me. I know that even if I choose not to have life
           sustaining treatment, I will still get medicines and treatments that ease my pain and
           keep me comfortable.

           [Instruction: Insert your initial by either “Yes” or “No” in the appropriate box]

           I want to have life sustaining treatment if I am terminally ill or injured.

           ____ Yes

           ____ No

       ii. Artificially provided Food and Hydration (food and water through a tube). I
           understand that if I am terminally ill or injured I may need to be given food and water
           through a tube to keep me alive if I can no longer chew or swallow on my own or
           with someone helping me.




© Copyright 2011 Docstoc Inc. registered document proprietary, copy not                  2
           [Instruction: Insert your initial by either “Yes” or “No” in the appropriate box]

           I want to have food and water provided through a tube if I am terminally ill or
           injured.

           ____ Yes

           ____ No

   b. If I Become Permanently Unconscious.

       Permanent unconsciousness is when my doctor and another doctor agree that within a
       reasonable degree of medical certainty, I can no longer think, feel anything, knowingly
       move, or be aware of being a
				
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Description: This Advanced Health Care Directive (Living Will and Health Care Proxy) is intended to be used by an individual located in South Dakota to express his or her directions regarding whether or not life-sustaining procedures are to be utilized in the event of the individual's incapacity. The directive provides for the appointment of a Health Care Proxy in case the individual is unable to speak for him or herself due to terminal illness, injury, or permanent unconsciousness. This document contains both standard provisions commonly found in advanced health care directives and opportunities for customization to address the specific directions of the individual.
This document is also part of a package Essential South Dakota Legal Documents 144 Documents Included