Durable Power of Attorney for Health Care 

  I,                         , execute this legal document as a formal 
  declaration of my informed and resolute treatment instructions. 

  1.  On the basis of my individual conscience as well as my faith in  
  (and my personal understanding of)  both the Hebrew and Christian 
  Scriptures, I direct that NO TRANSFUSIONS, INFUSIONS, OR INJECTIONS   
  OF WHOLE BLOOD OR ITS FRACTIONS AND DERIVATIVES be administered to me 
  under any circumstances, even if health-care providers believe that   
  such are necessary to preserve my life. I likewise refuse to pre-
  donate and store my own blood for later infusion. (Leviticus 17:10-13) 

  ( In a country that claims to guarantee religious freedom, I should   
  NOT be required to be a member of any religious sect for the above    
  stated faith and conscience to be respected.) See also Acts 15:28,29. 

  2.  I have ADDITIONALLY chosen, in harmony with the right of informed 
  choice implied in the laws of informed consent, and on the basis of   
  deeply held PERSONAL values & convictions which give life meaning,    
  to ENTIRELY AVOID medical (i.e. chemical, surgical & other allopathic) 
  therapies & proceedures (lNCLUDlNG HOSPITALIZATION) in favor of       
  numerous non-medical,  NON-SPIRITISTIC,  entirely physical and        
  biological therapies  (most Chiropractic and Naturopathic disciplines 
  as prime examples)  which, in my personal circumstances and experience 
  have proven reasonable, understandable and effective both in illness  
  AND INJURY (but which are not entirely compatible with traditional    
  western medicine). THIS IS NOT A DEATH WISH.  I will earnestly pursue 
  such so-called "alternative" therapies to the best of my ability.  I  
  firmly beg and INSIST that Emergency Medical Technicians (and others  
  who feel "responsible") respect this choice EVEN IF I AM UNCONSCIOUS. 

  I WOULD appreciate basic NON-BLOOD,  non-chemical,  non-invasive,     
  physical first aid if needed -- to arrest or retard profuse bleeding  
  or set and splint broken bones, for example.   If, in spite of        
  reasonable efforts, I appear to be dying, please take me home,        
  if at all possible, and let me die ( or revive ) IN PEACE.            

  In case it is not self-evident from the above instructions, I do      
  NOT want to be administered mechanical or chemical "ARTIFICIAL LIFE   
  SUPPORT" of any kind (including artifical nutrition and hydration) or 
  even "natural" therapies that function only as drugs and do not supply 
  the body with "resources" (such as energy or "building materials")  to 
  carry out it's own repair, maintenance, and internal "housekeeping".  

  3.  I realize there are risks to these choices, JUST AS THERE ARE     
  RISKS TO ALL MEDICAL THERAPIES, and hereby release those who have done 
  their best to follow these instructions from any charge of neglect.   

  I give no one ( including any appointed decision-making agents ) any  
  authority to disregard or override my instructions set forth herein.  
  Relatives, friends  OR  PROFESSIONALS  may disagree with me, but any  
  such disagreement does not diminish the strength or substance of my   
  ABSOLUTE REFUSAL OF BLOOD  or  my other decisions and instructions.   
                                                         _(Page 1 of 2)_


  4.  Health-Care Agents or Advocates: 
  While the above should leave very little to be decided by anyone 
  except accredited  non-medical, non-spiritistic  health-care 
  professionals, I appoint the person(s) named below as my advocate(s) 
  to take any necessary steps, including legal action, to ensure that my 
  decisions and instructions are honored.  I give my advocate(s) full 
  power and authority to consent to or to refuse treatment on my behalf, 
  (WITHIN BOUNDS OF THE ABOVE INSTRUCTIONS) to consult with appropriate 
  available health-care professionals, to obtain copies of any medical 
  records regarding my condition, and to make any other health-care 
  decisions not already set out above.  If my first appointed advocate 
  becomes unavailable, unable, or unwilling to serve, I appoint an 
  alternate advocate below to serve with the same power and authority.  
 . 

  ______________________________        ______________________________ 
           (ADVOCATE)                         (ALTERNATE ADVOCATE) 


  ______________________________        ______________________________ 
            (address)                             (address)


  ______________________________        ______________________________ 


  ______________________________        ______________________________ 
           (telephone/s)                         (telephone/s)
  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  . 
                                   .
     Durable Power of Attorney     .
         for Health Care           .  ______________________________
                                   .         (MY SIGNATURE)         
           -----------             .
       ! !  NO  BLOOD  ! !         .
           -----------             .  ______________________________
                                   .            (address)           
          NO  ARTIFICIAL           .
                                   .
          LIFE  SUPPORT            .  ______________________________
                                   .
     (Signed Legal Document)       .                        
                                   .  ______________________
  .  .  .  .  .  .  .  .  .  .  .  .  .  .   . (date) .  .   .   .  .  .
  5.  STATEMENT OF WITNESSES:    I attest that the person who signed  
  above,  voluntarily signed  or voluntarily directed another to sign  
  this document in my presence.  He or she appears to be of sound mind 
  and free from duress, fraud, or undue influence,  and is 18 years of 
  age or older,  as I also am.                                        


  ______________________________        ______________________________ 
         (signature)                          (signature)


  ______________________________        ______________________________ 
          (address)                             (address)
  _                                                      _(Page 2 of 2)_