(California Probate Code Section 4701)
[...] PART 2: INSTRUCTIONS FOR HEALTH CARE
If you fill out this part of the form, you may strike any wording you do not want.
(2.1) END-OF-LIFE DECISIONS: I direct that my health care providers and others involved in my care provide, withhold, or withdraw treatment in accordance with the choice I have marked below:
|_| (a) Choice Not To Prolong Life I do not want my life to be prolonged if
(1) I have an incurable and irreversible condition that will result in my death within a relatively short time,
(2) I become unconscious and, to a reasonable degree of medical certainty, I will not regain consciousness, or
(3) the likely risks and burdens of treatment would outweigh the expected benefits,
|_| (b) Choice To Prolong Life I want my life to be prolonged as long as possible within the limits of generally accepted health care standards.
(2.2) RELIEF FROM PAIN: Except as I state in the following space, I direct that treatment for alleviation of pain or discomfort be provided at all times, even if it hastens my death:
(Add additional sheets if needed.)
(2.3) OTHER WISHES: (If you do not agree with any of the optional choices above and wish to write your own, or if you wish to add to the instructions you have given above, you may do so here.) I direct that:
REGARDING THE PROVIDING of NUTRITION and HYDRATION
I FIRMLY believe that nutrition and hydration should be provided only by mouth, with my expressed cooperation and consent, UNLESS I am suffering from an illness from which there is some reasonable hope of recovery. If there is no reasonable hope (i.e. less than 10% probability) of my recovery, then I wish it to be clearly known that I find the use of artificially-administered nutrition and hydration utterly repugnant, both morally and psychologically. I am aware that these means are generally deemed "ordinary" and "proportionate" in most cases. However, even though these means may be regarded as "ordinary care", my moral and psychological reaction to the prospect of employing these means in the absence of any reasonable prospect for recovery can be summarized in the following five words: profound horror and complete revulsion. The Catholic moral tradition unambiguously affirms that these reactions may render "ordinary" means "extraordinary" for the individual who experiences them.
I SHOULD add that in stating this I am not expressing any desire for euthanasia or for any other action that would, of itself, hasten my death. My objection is solely limited to the use of artificial nutrition and hydration in the absence of any reasonable hope of recovery.
This Webpage was created for a workshop held at Saint Andrew's Abbey, Valyermo, California in 1990