It's important for you to have a voice in your health care.  Unfortunately, there may be times when you cannot make decisions or communicate because of your medical condition.  For example, you might have a severe head injury, blood infection (sepsis), or other condition that causes you to lack the functional ability to make your own decisions.
 
You should tell your doctor, friends, and family about the types of health care you would want/not want in advance of becoming severely ill.  You should also tell them about your values about life, health, health care, and dying.  These can be difficult concepts to think about, but they are important.  It is even MORE difficult to think about these things during a medical crisis when time is pressured and complex decisions need to be made.  If you can't speak for yourself, have you thought about who you would want to speak on your behalf?  Who would honor your values and wishes?  This is the person you want to appoint as your surrogate decision-maker (aka Durable Power of Attorney for Health Care, or Agent).    

The pdf form above provides a template for individual patient use (free) worldwide*. 
It allows you to make a Living Will.  You must be at least 18 years old and have decision-making capacity when you complete this form.  This copyrighted form is not for commercial or bulk use.  For commercial or bulk use, please contact me for permission and use fees.  Thank you.

   *If you are requesting interventions that are illegal in the country/state in which you are incapacitated, such will not be provided.  For example, Australia will not honor requests for euthanasia or physician-assisted suicide.  Switzerland will honor requests for physician-assisted suicide but not euthanasia.