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Pennsylvania Combined Living Will and Health Care Power of Attorney Form


Pennsylvania Combined Living Will and Health Care Power of Attorney Form
Pennsylvania Combined Living Will and Health Care Power of Attorney Form
Page 1
PENNSYLVANIA CATHOLIC CONFERENCE
Combined Living Will
and
Health Care
Power of Attorney
INSTRUCTIONS
1. Before completing your LIVING WILL and HEALTH CARE POWER OF ATTORNEY, you should discuss your
instructions with your health care agent (if any), family members, your doctor, priest, deacon, chaplain, or
anyone else who may become responsible for your care. This form was developed by Pennsylvania’s Catholic
Bishops to offer ethical and religious guidance. Consult with an attorney if you have legal questions about
your LIVING WILL and HEALTH CARE POWER OF ATTORNEY. This form is not intended to take the place of
specific legal advice.
2. You should periodically review this LIVING WILL and HEALTH CARE POWER OF ATTORNEY with those
same people to insure that this directive always reflects your wishes.
3. You can revoke this directive at any time in any manner. The revocation is effective as soon as you,
or someone who witnesses your revocation, communicate it to your attending physician or other health care
provider. If you decide to revoke this LIVING WILL and HEALTH CARE POWER OF ATTORNEY make sure that
your doctor and any health care agent you appoint receive notice of the revocation.
4. Two witnesses who are at least 18 years of age are required by Pennsylvania law. If someone signs
this form on your behalf, that person may not also be a witness. Someone who will inherit property from you;
is a creditor of yours, or is an employee of your health care provider should
not sign as a witness.
ADVANCE HEALTH CARE DIRECTIVE
I. PREAMBLE
Our Christian heritage holds that life is the gift of a loving God.
I understand and believe, as a Catholic, that I may never choose to directly cause or hasten my death. I
believe that euthanasia is the deliberate act of taking the life of another, whether by active intervention or by
omitting an action with the intention of causing death. I believe that euthanasia constitutes an unwarranted
destruction of human life and is never morally permissible.
I also believe that suicide (and assisted suicide) are never morally permissible.
I understand that I have the right to make decisions about my health care. There may come a time when I am
unable, due to physical or mental incapacity, to understand, make or communicate my own health care
decisions. In such circumstances, those caring for me will need direction concerning my care and will turn to
someone who knows my values and health care wishes. I am, therefore, signing the attached LIVING WILL
and HEALTH CARE POWER OF ATTORNEY [which is my advance directive for health care] to provide the
guidance and authority needed to implement decisions for me, and especially if I have an end-stage medical
condition or am permanently unconscious (as those terms are defined in Pennsylvania law).
Pennsylvania Combined Living Will and Health Care Power of Attorney Form
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