Declaration Provided by Maine Revised Statutes Title 22 Section 2922

DECLARATION 

If I should have an incurable or irreversible condition that will cause my death within a short time, and if I am unable to participate in decisions regarding my medical treatment, I direct my attending physician to withhold or withdraw procedures that merely prolong the dying process and are not necessary to my comfort or freedom from pain. 

Signed this _____________ day of _______________________________ 
date                month                  year 

Signature ______________________________________________ 

The Declarant is known to me and voluntarily signed this document in my presence. 

Witness ________________________________________________ 

Address: 

Witness ________________________________________________ 

Address: 

Declaration Provided by Maine Revised Statutes Title 22 Section 2922
Review List

This review list is provided to inform you about this document in question and assist you in its preparation.  This simple Life Sustaining Declaration is valid in Maine. Check with a local hospital or doctor’s office, as well as with an experienced medical attorney, to assure yourself of its compliance with current statute (s) in your state.

1.	Make multiple copies.  Give one to your doctor (s), the local hospital, and have others available through your attorney and family.  Remember, these kinds of documents are needed in emergency situations at worst and under stressful circumstances at best.  So be sure they are available to the appropriate people easily, when needed.