LIVING WILL

I, [FIRST NAME LAST NAME, PERSONAL IDENTITY CODE], express with this
living will my wishes in case I am unable to take part in decisions
concerning my care.

1. If, according to medical assessment, there is no hope of my recovery
from an incurable illness or injury, I refuse treatment that artificially
maintains life [FOR EXAMPLE: resuscitation, ventilator treatment,
artificial nutrition and hydration — EDIT ACCORDING TO YOUR OWN WISHES].

2. I always want sufficient pain relief and good symptomatic care, even
if it shortens my life.

3. My other wishes: [FOR EXAMPLE: place of care, spiritual support, who I
wish to be kept informed — OR DELETE THIS POINT].

4. [OPTIONAL: I wish my care to be discussed with the following person:
NAME, PHONE NUMBER, RELATIONSHIP TO ME.]

This living will is valid until further notice. I can change or cancel it
at any time.

[PLACE AND DATE]
[SIGNATURE AND NAME IN PRINT]

Witnesses (recommended, not required):
We certify that [NAME] has signed this living will in person and stated
that it corresponds to their wishes.

Witness 1: [SIGNATURE, NAME IN PRINT, DATE]
Witness 2: [SIGNATURE, NAME IN PRINT, DATE]