I, __________________________, being of sound mind and body, do not wish to be kept alive indefinitely by artificial means.

I, __________________________, being of sound mind and body, do not wish to be kept alive indefinitely by artificial means. Under no circumstances should my fate be put in the hands of pinhead politicians who couldn't pass ninth-grade biology if their lives depended on it, or lawyers/doctors interested in simply running up the bills. If a reasonable amount of time passes and I fail to ask for at least one of the following: ______a cold beer ______a glass of wine ______a Bloody Mary ______a Margarita ______a Scotch and soda ______a Martini ______a Vodka and Tonic ______ a Bourbon on the rocks ______a Steak ______Lobster or crab legs ______The remote control ______a Bowl of ice cream ______The sports page ______ a new rifle ______Chocolate ______Sex it should be presumed that I won't ever get better. When such a determination is reached, I hereby instruct my appointed person and attending physicians to pull the plug, reel in the tubes and call it a day. Signature: ___________________________ Date: ___________________________