[Lisa]

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:

______Scotch and water
______Glass of wine
______Margarita
______Martini
______Steak and baked potato
______Chicken fried steak and cream gravy
______Mexican food
______Hamburger and fries
______Pizza
______The remote control
______Bowl of ice cream
______Double Espresso
______Chocolate
______Sex
______Personal Selection: ____________________________________

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.

Notarized by: ____________________________
Date: ___________