Healthcare Power of Attorney and Living Will Combined Form

Healthcare Power of Attorney & Living Will

  • as my agent for all matters relating to my healthcare, including, full power to give or to 
refuse consent to all medical, surgical, hospital and related health care. This power of 
attorney is effective whenever I am unable to make or to communicate health care 
decisions. All of my agent’s actions under this power have the same, effects on my heirs, 
devisees, and personal representatives as if I were alive, competent and acting for myself.

    
In acting under this power, I want my agent to give great weight to the following 
statements: I am in favor of trial treatment -that means I want all necessary medical care 
to treat my condition until, and only until my doctors and my agent reasonably decide 
that I am in an irreversible state. If following the guidelines stated above, my doctors 
and my agent decide that further medical care is inappropriate:

    
I want only comfort care and I do not want to undergo artificial administration 
of food or fluids. 
I do not want to be resuscitated in case I stop breathing or my heart stops beating. 


    If my doctors and my agent reasonably decide that I have a terminal illness, I want all 
decisions concerning my medical and surgical care to be made in light of the expected 
length and quality of life which would result from such care and the predictable effects 
on me of undergoing treatment if I cannot be expected to have a significant period of 
conscious life even after medical or surgical care, then I want comfort care only.

    
This combined health care directive is made under ars 36-3221 and 36-3261 , Arizona 
Revised Statutes. It continues in effect for all who may rely on it, except those to whom I 
have given notice of its revocation. 


Member, American Society of Plastic Surgeons
Member, American Society for Aesthetic Plastic Surgery

Call us at 520-881-3232

4580 East Camp Lowell Drive - Tucson, Arizona - 85712