Alaska Durable Power Of Attorney For Health Care Decisions
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8PART 1
ALASKA DURABLE POWER OF ATTORNEY
FOR
HEALTH CARE DECISIONS
(1) DESIGNATION OF AGENT.
I designate the following individual as my agent to make health care decisions for me:
Name
Address
City
State
Zip
Phone: Home
Work
OPTIONAL: If I revoke my agent's authority or if my agent is not willing, able, or reasonably available to
make a health care decision for me, I designate as my first alternate agent:
Name
Address
City
State
Zip
Phone: Home
Work
OPTIONAL: If I revoke the authority of my agent and first alternate agent or if neither is willing, able, or
reasonably available to make a health care decision for me, I designate as my second alternate agent:
Name
Address
City
State
Zip
Phone: Home
Work
(2) AGENT'S AUTHORITY.
My agent is authorized and directed to follow my individual instructions and my other wishes to the
extent known to the agent in making all health care decisions for me. If these are not known, my agent is
authorized to make these decisions in accordance with my best interest, including decisions to provide,
withhold, or withdraw artificial hydration and nutrition and other forms of health care to keep me alive,
except as I state here:
_____________________________________________________________________________________
_____________________________________________________________________________________
_____________________________________________________________________________________
_____________________________________________________________________________________
Under this authority, "best interest" means that the benefits to you resulting from a treatment outweigh the
burdens to you resulting from that treatment after assessing
(A) the effect of the treatment on your physical, emotional, and cognitive functions;
(B) the degree of physical pain or discomfort caused to you by the treatment or the withholding or
withdrawal of treatment;
(C) the degree to which your medical condition, the treatment, or the withholding or withdrawal
of treatment, results in a severe and continuing impairment;
America Living Will Registry, LLC • 2814 Beach Boulevard South • St. Petersburg, FL 33707 • 866-305-ALWR • •
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