以下是來自加州，就個人生存意願以及醫療指示，所研擬出一份嚴謹的文件，可從中了解到美洲國家，對"生命"的重視!
台灣可以見賢思齊，具備全球化思維，在地化作為，攜手擬定一套適合台灣的Living Will! 

＊譯者:鄺允銘 先生

          ADVANCE MEDICAL DIRECTIVE AND
        POWER OF ATTORNEY FOR HEALTH CARE
                    GIVEN BY
               HOMER ROGER SIMPSON

                     PART 1
         POWER OF ATTORNEY FOR HEALTH CARE
                
(1)DESIGNATION OF AGENT: I designate the following individual as my agent to make health-care decisions for me: Marge Simpson whose residence is 123 Simpson Way, Springfield and whose telephone number is 222-111-0101.
If Marge Simpson shall be unable or unwilling to act as my agent for health-care decisions, I designate the following individual to act as my successor agent: Lisa Simpson whose residence is 123 Simpson Way, Springfield and whose telephone number is 222-111-0101.

(2)AGENT'S AUTHORITY: My agent is authorized to make all health-care decisions for me, including those forms of health care necessary to keep me alive. Furthermore, the authority I give my agent shall include decisions to provide, withhold, or withdraw artificial nutrition. The power of my agent granted herein shall not be affected by my subsequent incapacity.

(3)WHEN AGENT'S AUTHORITY BECOMES EFFECTIVE: My agent's authority becomes effective when both (1) my attending physician determines that I am no longer able to understand, appreciate, and direct my medical treatment and (2) two physicians--one of whom is my attending physician and the other is qualified and experienced in making such diagnosis--have personally examined me and have diagnosed and documented in my medical records that I am either terminally ill or that I am in a state of persistent unconsciousness with no reasonable expectation of recovery.

(4)AGENT'S OBLIGATION: My agent shall make health-care decisions for me in accordance with this power of attorney for health care and any instructions I give in Part 2 of this form. To the extent my wishes are unknown, my agent shall make health-care decisions for me in accordance with what my agent determines to be in my best interest. In determining my best interest, my agent shall consider my personal values to the extent known to my agent.

(5)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 form. If that agent is not willing, able, or reasonably available to act as guardian, I nominate the alternate agents whom I have named, in the order designated.

                     PART 2
          INSTRUCTIONS FOR HEALTH CARE

I have the primary right to make my own decisions concerning treatment that might unduly prolong the dying process. By this declaration, I express to my physician, family and friends my intent.

(6)END-OF-LIFE DECISIONS: In cases where both (1) my attending physician determines that I am no longer able to understand, appreciate, and direct my medical treatment and (2) two physicians--one of whom is my attending physician and the other is qualified and experienced in making such diagnosis—have personally examined me and have diagnosed and document in my medical records that I am either terminally ill or that I am in a state of persistent unconsciousness with no reasonable expectation of recovery, I direct that my health-care providers and others involved in my care provide, withhold, or withdraw treatment in accordance with the choices I have stated below. The word "Withhold" shall be used to mean both withholding the treatment if it has not yet been given and withdrawing the treatment if it is currently being administered.

Withhold: Artificially supplied nutrition and hydration (including tube feeding or food and water)、Surgery or other invasive procedures (i.e., those where medical instruments must enter the body)、Heart-lung resuscitation (CPR)、Antibiotics、Kidney or Renal dialysis、Mechanical ventilator (respirator)、Chemotherapy and other radiation therapy、All other "life sustaining" medical procedures that are merely intended to keep me alive without reasonable hope of improving my condition

I hereby acknowledge the above choices: 

_____________________________________
Homer Roger Simpson 
Declarant / Principal

(8)RELIEF FROM PAIN: I direct that I be given medical treatment to relieve pain or to provide comfort, even if such treatment might shorten my life, suppress my appetite or my breathing, or be habit-forming.

                    PART 3
         DONATION OF ORGANS AT DEATH
                  (OPTIONAL)

(8)ORGAN DONATION: Upon my death, I wish to donate any and all of my organs, tissues, or other bodily parts for use in transplant to another human being. I authorize my health care agent to give consent to the medical organization of his choosing for donation of my aforementioned body parts.

                    PART 4
               PRIMARY PHYSICIAN
                  (OPTIONAL)

(9)DESIGNATION OF PHYSICIAN: I designate the following physician as my primary physician: Dr. Albert Bundy.

(10)EFFECT OF COPY: A copy of this form has the same effect as the original.

(11)DURABILITY OF HEALTH CARE AGENT'S POWERS: This Health Care Power of Attorney is a durable power of attorney and the authority of my agent shall not terminate if I become disabled or incapacitated or in the event of later uncertainty as to whether I am dead or alive. If I have also executed a durable financial power of attorney, this document is not meant to override that document. My health care agent's powers only extend to health care decisions as outlined in this document.

(12)DEFINITIONS:
"Artificially Provided Nutrition and Hydration" means feeding a patient through a means that is not natural such as (1) intravenously (i.e., inserting a needle directly into a patient's veins through which food or water would be forced into the patient's blood stream) or (2) a feeding tube inserted in the nose or mouth through which food or water would be forced into an individual's stomach. Assisted feeding, such as by a spoon or bottle, where the patient actively participates in the feeding process by chewing or swallowing is not considered "artificially provided nutrition and hydration".

"Persistently Unconscious" means a condition that, to a reasonable degree of medical certainty: (a) will last permanently without improvement, (b) one in which cognitive thought, purposeful action, and awareness of self and environment are absent, and (c) which has existed for a period of time sufficient, in accordance with applicable medical standards, to make a diagnosis called for in parts (a) and (b) hereof.

"Terminally Ill" means an incurable and irreversible condition that, without the administration of life-sustaining treatment, will, to a reasonable degree of medical certainty, result in death within a relatively short time.

"Life-Sustaining Treatment" means any medical treatment, procedure, or intervention that, in the judgment of the attending physician, when applied to the patient, would serve only to prolong the dying process where the patient has a terminal illness or injury, or would serve only to maintain the patient in a condition of permanent unconsciousness. These procedures shall include, but are not limited to, surgery, chemotherapy, CPR, dialysis, use of mechanical respirators, blood transfusions, and the administration of all drugs and antibiotics (except those intended to ease pain).

IN WITNESS WHEREOF, I sign the foregoing as my Health Care Directive and Medical Power of Attorney, do it willingly and as my free and voluntary act for the purposes herein expressed, and further state that I am eighteen years of age or older, of sound mind, and under no constraint or undue influence, this ___   day of November, 2003.

_______________________________ (Please also sign on page 3 above.)
Homer Roger Simpson
Declarant / Principal

City and State of Residence: Springfield, California
Social Security Number: 377103333

STATE OF CALIFORNIA       )
                             ) SS.
COUNTY OF _________________)

I, the undersigned, a Notary Public authorized to administer oaths in the State of California, certify that Homer Roger Simpson, the Declarant of this instrument, having appeared before me and having been first duly sworn, has declared to me that he or she has willingly signed and executed the instrument as his or her Medical Directive and Medical Power of Attorney, and that he or she executed such instrument as his or her free and voluntary act for the purposes therein expressed.

IN WITNESS WHEREOF, I have hereunto subscribed my name and affixed my official seal this ____ day of November, 2003.
________________________________ My Commission Expires: _______________
Notary Public 

＊＊＊＊＊＊＊＊＊＊＊＊＊＊＊＊＊＊＊＊＊＊＊＊＊＊＊

                   壹、 醫療照護委任書
（1） 代理人：
本人茲委任  Marge Simpson 女士   
（住址：________________電話：_________）為本人之代理人，就本人接受醫療照護一事代為意思表示。
如  Marge Simpson 女士  就前項醫療照護一事，因故不能或拒絕代本人為意思表示時，由  Lisa Simpson 女士（住址：________________電話：_________）繼任為代理人，就前項醫療照護一事代本人為意思表示。 

（2） 代理人之權限：
代理人得為本人之利益，就前述醫療照護一事，代本人為所有之意思表示，包括以何種醫療方式維繫本人之生命等在內。代理人並有權決定提供、停止或取消以人為之方式維繫本人之生命。
前項代理人之權限，不因本人日後因故喪失行為能力而終止。

（3）代理權限之啟始：
代理人應於下列條件全部成就時，行使其代理權：
1)本人之主治醫師判定本人已喪失意識能力，致無法就接受醫療照護一事為適當之意思表示時；且，
2)有兩名醫師，其一為本人之主治醫師，另一為具有專業判斷能力之合格醫師，共同診斷，並以書面之醫療記錄表示，認為本人已極度病危而回生乏術；或認為本人持續處於喪失意識之狀態，已無合理之理由足以期待本人仍有回復意識之可能性時。

（4）代理人之義務：
代理人應依本委任書之內容及委任書第二部分之指示，為本人之利益，就本人接受醫療照護一事，代表本人為意思表示。如本人之意思有部分不明或無法得知時，代理人應以最符合本人利益之方式，為適當之意思表示。
代理人為前項之適當意思表示時，應就其已知，考量本人個人之價值，而為適當之意思表示。

（5）監護人之指定：
如法院基於本人之利益而欲指派監護人時，本人指定前述第一順位代理人為本人之監護人。如第一順位代理人因故不能、拒絕或不適任擔任本人之監護人時，由第二順位代理人遞補之。

                   貳、 醫療指示

本人茲聲明，本人有權就可能涉及不當苟延本人生命之醫療行為做處置。本人並藉此委任書向本人之主治醫師、家人及親友明白表示前項意旨。

（6） 臨終前之處置：
本人茲要求提供本人醫療照護之機構，及其他共同照護本人之人員，於下列條件同時成立時，依據本人以下之指示，進行處置：
1）本人之主治醫師判定本人已喪失意識能力，致無法就接受醫療照護一事為適當之意思表示時；且，
2）有兩名醫師，其一為本人之主治醫師，另一為具有專業判斷能力之合格醫師，共同診斷，並以書面之醫療記錄表示，認為本人已極度病危而回生乏術；或認為本人持續處於喪失意識之狀態，已無合理之理由足以期待本人仍有回復意識之可能性時。

以下所述「停止執行」（Withhold）一詞，意指「尚未提供者，不予提供」或「已提供者，停止其提供」。

停止執行:以人為方式補充養分及水分（包括插管餵食食物及水分)、外科手術或其他侵入性手術（亦即醫療器材必需侵入體內者〉、心肺復甦術 （CPR）、抗生素、洗腎、人工呼吸器、化學治療及其他放射線治療、其他所有之「維持生命之醫療手段」，該等手段僅足以苟延本人之生命，而無相當之可能性足以改善本人之狀況者
	
本人特此聲明，以上各項指示確為本人之意旨。

_____________________________________    
聲明人（即本人） 

（8）痛苦之減輕：
本人要求給予適當之醫藥以減輕或消除本人身體所受之痛苦，縱使該等醫藥可能導致本人壽命之減損、食慾不振、呼吸不易、或藥物上癮者亦然。

               參、 器官捐贈（自由填寫）

（8）器官捐贈：
本人願意於往生後，立即捐出本人身體之全部器官、組織、或其他部份，以供移植於他人使用。本人並授權代理人，得同意所選定之醫療機構之請求，捐出以上所述本人身體之各部分。

           肆、 主治醫師之指定（自由填寫）
（9）主治醫師之指定：
本人茲指定  Albert Bundy 醫師為本人之主治醫師。

（10）委任書副本之效力：
本委任書副本之效力與正本相同。

（11）代理權之範圍及期限：
本委任書生效後，代理人之權限並不因本人嗣後因故殘障，或喪失行為能力，或陷入昏迷致生死不明，而失其效力。
前項代理權限行使之範圍，應僅止於就本人接受醫療照護一事，依據本委任書之內容所示，行使代理。
如本人另有簽發財務委任書時，該財務委任書係獨立有效，不得以本委任書取代該財務委任書。

（12）名詞定義：
「以人為方式補充養分及水分」一詞，係指以「非自然」之方式對病患提供養分及水分。例如：
1）靜脈注射（意即將針管插入病患之靜脈血管中，以便將養分或水分輸入至病患之血液裏）； 或，
2）將導流管插入病患之鼻腔或口腔中，以便將食物或水分強行灌入病患之胃中。
至如「輔助性餵食」，例如藉由湯匙或瓶罐等器材之輔助以餵食病患，則因病患本身實際上有參與咀嚼並吞嚥食物之過程，即非此處所指之「以人為方式補充養分及水分」。

「持續無意識狀態」一詞，係指從醫學之角度而言，可以合理相信：
（a）該狀態將永久持續而無改善之可能；
（b）病患已無法辨識人事物、無法從事有意識之活動、無知覺亦無法感覺周圍之環境； 且，
（c）以現有醫學上之標準而言，該狀態已屬持續相當之時間，致足以確認（a）、（b）兩項事實。

「極度病危」一詞，係指病情嚴重，無法治療亦無法康復，且如不採取維持生命之醫療手段時，醫學上可以合理相信病患即將於很短之時間內死亡者。

「維持生命之醫療手段」一詞，係指當病患處於極度病危或嚴重受傷之狀況下，醫護人員所採取之任何之治療、程序、干預等手段；且此等手段之施行，從主治醫師之觀點而言，僅足以苟延病患之生命，而無實際療效，或僅足以使病患維持持續無意識之狀態者。此等手段包括，但不僅限於，外科手術、化療、心肺復甦術、洗腎、人工呼吸、輸血、以及使用所有之藥物及抗生素等（為減輕病患痛苦所使用之藥物，不在此限）。

本人茲聲明，本人係出於自願，且於自由之意志下，以達成本人之意願為目的，簽署本委任書及其所包含之各項醫療指示。本人並聲明，本人已年滿18歲，心智成熟，於未受拘束及不當影響之情況下，於_______年_______月_______日 簽署本委任書。
_______________________________（亦已於第3頁簽名）
Homer Roger Simpson
聲明人/本人
地址：加州春田市
社會保險號碼：377103333
加州                   )
                       ) SS.( Scilicet)亦即
___________ 郡         )


本人，加州合格登錄之公證人，茲證明，Homer Roger Simpson先生，即本件文書之聲明人，係親自於本人之前完成宣誓，並聲明其簽署本件醫療指示及醫療照護委任書，係出於自願，並本於其個人之自由意志，於未受拘束之情況下，為達成其個人之目的而完成簽署者。

基於以上之事實，本人茲於_______年_________月_________日 副署本人之簽名及職章以茲證明。

公證人：___________                            
執照有效期限至：___________                    

＊資料來源: https://www.medlawplus.com/