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Durable Power of Attorney for Health Care

2. Effective Date And Durability
This power of attorney shall become effective only if I become incapacitated. By incapacity I mean that I am unable to understand and appreciate the nature and consequences of proposed health care and to make and communicate an informed health care decision. It shall continue in effect until I am able to resume the management of my health care or until my death.

3. Declaration Of My Wishes
I do not wish to prolong my life through medical intervention if, after such intervention, I would reasonably be expected for the foreseeable future (a) to live in intractable pain, (b) to be substantially dependent upon others in order to accomplish the basic life functions of eating, communicating or maintaining personal hygiene, (c) to be unable to exchange affection with my loved ones, (d) to be unable to regain substantial cognitive, communicative and interactive faculties or (e) to be in such other circumstances such that, in the opinion of my agent, the burden of sustaining my life degrades my humanity. It is also my expressed and deeply held desire not to exist in a persistent vegetative state.

4. Agent's Powers
Without limitation of the powers conferred upon her or him by statute or general rules of law, my agent shall have the power to act in my name, place and stead in any way which I myself could do with respect to decisions regarding my health care. If my agent cannot determine the choice I would want made, then she or he shall make a choice for me based upon what she or he believes to be in my best interest. My agent's authority to interpret my desires is intended to be as broad as possible. This authority shall include, by way of illustration only and not by way of limitation, the following decisions on my behalf:

A. to consent, refuse, or withdraw consent to any and all types of medical care, treatment, surgical procedures, diagnostic procedures, medication, food and hydration and the use of mechanical or other procedures that affect any bodily function, including (but not limited to) artificial respiration and cardiopulmonary resuscitation. I do not wish to be on life support for more than a week if it is not evident that I will emerge in good health;

B. to consent to the entering of a "do not resuscitate" or similar order.

C. to have access to medical records and information to the same extent that I am entitled to, including the right to disclose the contents to others;

D. to authorize my admission to or discharge (even against medical advice) from any hospital, nursing home, residential care, assisted living or similar facility or service;

E. to contract on my behalf with any health care related service or facility without my agent incurring any personal financial responsibility for my care;

F. to hire and fire medical, social service, and other support personnel responsible for my care;

G. to authorize any medication or procedure intended to relieve pain, even though such use may lead to physical damage, addiction, or hasten the moment of my death;

H. to make anatomical gifts of part or all of my body for medical purposes, authorize or withhold authorization to perform an autopsy, and direct the disposition of my remains, to the extent permitted by law;

I. to take any other action necessary to do what I authorize here, including but not limited to granting any waiver or release from liability required by any hospital, physician, or other health care provider; signing any documents relating to refusals of treatment or the leaving of a facility against medical advice, and pursuing any legal action in my name and at the expense of my estate to force compliance with my wishes as determined by my agent, or to seek actual or punitive damages for the failure to comply;

J. to move me from one physician, facility or jurisdiction to another to carry out my wish to die with as much dignity as the law of any jurisdiction would provide;

K. If I am dying, I ask my agent to engage Hospice to provide my care to the greatest extent possible.

5. Validity
This power of attorney is intended to be valid in any jurisdiction in which it is presented.

6. Nomination Of Guardian
If a guardian of my person needs to be appointed for me by a court, I nominate the agent designated in this power of attorney. If that agent is not willing, able or reasonably available to act as guardian, I nominate the alternate agent whom I have named.

7. Effect Of Copy
A copy of this power of attorney for health care has the same effect as the original.

8. Revocation
I understand that I may revoke this document at any time, and that if I revoke it, I should promptly notify my supervising health-care provider and any health-care institution where I am receiving care and any others to whom I have given copies of this power of attorney. I understand that I may revoke the designation of an agent only by a signed writing or by personally informing the supervising health-care provider.

I sign my name to this health care power of attorney on this _______ day of ________________________. (month)

________________________________________(name)

________________________
Witness

________________________
Witness

STATE OF NEW MEXICO )
                                               ) ss.
COUNTY OF _________   )

Sworn to before me this _______ day of ____________________, by _________________________.

_________________________ Notary Public

My commission expires:

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Elizabeth Fisher
500 S. Main Street, 10^th floor
P.O. Box 8052
Las Cruces, NM  88006
(505) 523-4321
Fax: (505) 526-6679

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