DO NOT authorize the withholding or withdrawal of artificially provided food, water, or other artificially provided nourishment or fluids. Authorize my surrogate, designated above, to withhold or withdraw artificially provided nourishment or fluids, or other treatment if the surrogate determines that withholding or withdrawing is in my best interest; but I do not mandate that withholding or withdrawing. ANATOMICAL GIFT Authorize the giving of all or any part of my body upon death for any purpose specified in KRS 311.185. prolonging treatment and artificially provided nutrition and hydration, it is my intention that this directive shall be honored by my attending physician, ADD PERSONAL my family, and any surrogate designated pursuant to this directive as the INSTRUCTIONS final expression of my legal right to refuse medical or surgical treatment and (IF ANY) I accept the consequences of the refusal. DO NOT authorize the giving of all or any part of my body upon my death. If I have been diagnosed as pregnant and that diagnosis is known to my attending physician, this directive shall have no force or effect during the Other course of my pregnancy. I understand the full import of this directive and I am emotionally and mentally competent to make this directive. In the of my ability to give the use of life-
DO NOT authorize the withholding or withdrawal of artificially provided food, water, or other artificially provided nourishment or fluids. Authorize my surrogate, designated above, to withhold or withdraw artificially provided nourishment or fluids, or other treatment if the surrogate determines that withholding or withdrawing is in my best interest; but I do not mandate that withholding or withdrawing. ANATOMICAL GIFT Authorize the giving of all or any part of my body upon death for any purpose specified in KRS 311.185. ADD PERSONAL INSTRUCTIONS (IF ANY) DO NOT authorize the giving of all or any part of my body upon my death. Other In the of my ability to give the use of life- prolonging treatment and artificially provided nutrition and hydration, it is my intention that this directive shall be honored by my attending physician, my family, and any surrogate designated pursuant to this directive as the final expression of my legal right to refuse medical or surgical treatment and I accept the consequences of the refusal. If I have been diagnosed as pregnant and that diagnosis is known to my attending physician, this directive shall have no force or effect during the course of my pregnancy. I understand the full import of this directive and I am emotionally and mentally competent to make this directive.