To my family, my friends, my physicians and all others
who may be interested:
I, Brian Andrew Schmidt, request that I be kept
informed of my medical condition. Whenever possible I
want to participate in decisions regarding my medical
treatment, including whether any measure should be
taken to prolong my life. If my physicians determine
that I am incapable of making or communicating my own
health care decisions, this directive should be used
to ascertain my decisions and desires.
In the event my physicians determine, to a reasonable
degree of medical certainty, that I have a terminal
condition or that I am permanently unconscious, I
direct that I not be provided medical treatment that
merely will serve to prolong my dying or continue my
unconscious state. In such an event, I do want those
measures that will keep me comfortable and relieve
pain, even if they will render me unconscious or
hasten my death.
I am providing the following specific instructions to
help my physicians and proxies understand my desires.
These instructions are not meant to preclude measures
that would provide comfort or relieve pain or would
otherwise serve a purpose other than to prolong my
dying or continue my unconscious state.
I do not want tube feeding or any other artificial or
invasive form of nutrition (food) or hydration
I consent to the use of my body for organ donation or
scientific research. My body can be kept alive by
whatever means necessary for a reasonable period for
the purpose of organ donation or for scientific use.
So the last paragraph was mine - it puts some wriggle room in the document, but given my family, I don't see that as a problem. If you want to give less discretion, you could remove "reasonable period" and insert "up to one week" or whatever time period you want.
Don't forget to add signature lines and proxy designations, also found at the Penn Medical Society website.
I think this is fine for a healthy adult - if you're meticulous or want more detail, there's also the "Five Wishes" document, but you have to pay $5 to get it. Or heck, hire a lawyer - if money is no object.