I, __________________________, being of sound mind and body, do not wish to be kept alive indefinitely by artificial means. Under no circumstances should my fate be put in the hands of pinhead partisan politicians who couldn't pass ninth-grade biology if their lives depended on it or lawyers, doctors, hospitals interested in simply running up the bills.
If a reasonable amount of time passes and I fail to ask for at least one of the following: __X____a Martini ___X___a Margarita __X____ a Scotch______a Bloody Mary ______a Gin and Tonic ___X____a Glass of Chardonnay _X_____a Steak ___X___Lobster or crab legs ______The remote control ___X___a bowl of ice cream __X____The sports page __X____Chocolate or __XXXX____Sex,
It should be presumed that I won't ever get any better. When such a determination is reached, I hereby instruct my appointed person and attending physicians to pull the plug, reel in the tubes and call it a day.At this point, it is time to call the New Orleans Jazz Funeral Band to come do their thing at my funeral, and ask all of my friends to raise their glasses to toast the good times we have had.
Signature: ___________________________ Dated this _____day of ______________, 200 __