STATEMENT OF MY WISHES

1. My proxy. I name [name, relationship, phone] as my health-care agent, and [name, phone] as my alternate.

2. The line. I do not want my life prolonged once my doctor and my proxy agree that I am unlikely ever again to [recognize the people I love / hold a conversation / read, or follow a story / live outside a nursing facility / other signs, in my words].

3. Past the line, I refuse. Resuscitation; a breathing machine; dialysis; surgery; transfer to a hospital, unless it's the only way to relieve my suffering; antibiotics and other treatment for infections such as pneumonia; and artificial nutrition and hydration.

4. Food and drink. [I want food and drink offered only when I show that I want them, for comfort, and never pressed on me. / I do not want to be fed by hand.] Opening my mouth when food is offered is not consent to being kept alive by it.

5. Comfort. I want my pain, breathlessness and distress treated fully, with hospice care, even if the treatment may shorten my life.

6. What I mean by a life I'd enjoy. [In my own words, while I can still write them.]

7. For my proxy. If, past this line, I seem content, [follow this document anyway: I wrote it knowing I might / let my contentment count, and decide as you think best].