To my family physician, my lawyer, my friends, and all others to whom it may concern:
I, _____________________, being of sound and disposing mind and memory, do hereby make, publish and declare this to be my LIVING WILL. If the time comes when I can no longer take part in decisions of my own future, let this statement stand as an expression of my wishes and directions while I am still of sound mind.
If I suddenly begin to take an unexplained turn for the worse, before any drastic or irreversible decisions are made, it is my desire that someone first check to make sure my attending physician is not Dr. Jack Kevorkian.
Should my attending medical personnel determine that an organ transplant is necessary, it is my expressed wish that, if at all possible, the baboon be of the same faith as me.
If a kind soul takes it upon themself to read aloud to me, it is my fervent wish, as it was during my non-incapacitated life, that they skip directly to the dirty parts of the book, and then read those passages over and over and over again.
It is my expressed want that no family member, friend or acquaintance shall enter my hospital room bearing one of those tacky "Get Well Soon" helium balloons. Likewise, any get well card sporting Garfield the Cat shall immediately be returned to its sender.
I wish my TV set off whenever "Oprah" or “The View” are on.
If at all possible, I prefer "Depends" over "Serenity."
I would prefer that my visitors leave their small children home if all the kids are going to do is stare at me and play with my toes.
When it comes time to change my Foley catheter, I would prefer a nurse with untreated Parkinson’s disease perform the procedure while singing "Barnacle Bill the Sailor" to me.
At no time, even on the occasion of my birthday, do I desire to have a party hat placed on my head.
While I am not morally or ethically opposed to so-called “life sustaining equipment," I am vehemently opposed to the concept of hooking up such machinery to "The Clapper."
I agree to sponge baths only if given by a member of the opposite sex. Several members of the opposite sex at once is certainly acceptable and, in fact, preferred. Ditto for any "therapeutic Jacuzzis" that may be prescribed.
Please kill anybody trying to enroll me in Wii-Hab or similar nonsense.
It is my strong desire that in any and all elections that may take place, my absentee ballot be marked for the individual running opposite Barney Frank.
In the unfortunate event that the time comes to donate my vital organs, it is my wish that in all donations, a receipt be obtained for tax purposes. Also, do not give my organs to anybody associated with the IRS or the United States Postal Service—let those bastards die a slow and painful death.
No Jello or Ensure. Margaritas with Patron Tequila (preferably the Grand Platinum variety) will be acceptable.
When it comes time for me to give up the ghost, make sure the embalmer leaves a smile on my face.
This statement is made after careful consideration and is in accordance with my strong convictions and beliefs I want the wishes and directions here expressed carried out to the extent permitted by law.
IN WITNESS WHEREOF, I have hereunto set my hand and seal to this my LIVING WILL on this the ___ day of _______________, 20_______
THIS FORM MAY BE PRINTED FOR PATIENT USE.