_________ (Initials) If my heart or pulse has stopped, I want to have
cardiopulmonary resuscitation (CPR) used.
(8) ADDITIONAL STATEMENTS
[This section is optional.
PART TWO will be effective even if this section is
left blank. This section allows you to state additional treatment
preferences, to provide additional guidance to your health care agent (if
you have selected a health care agent in PART ONE), or to provide
information about your personal and religious values about your medical
treatment. For example, you may want to state your treatment preferences
regarding medications to fight infection, surgery, amputation, blood
transfusion, or kidney dialysis. Understanding that you cannot foresee
everything that could happen to you after you can no longer communicate
your treatment preferences, you may want to provide guidance to your
health care agent (if you have selected a health care agent in PART ONE)
about following your treatment preferences. You may want to state your
specific preferences regarding pain relief.]
(9) IN CASE OF PREGNANCY
[PART TWO will be effective even if this section is left blank.]
I understand that under Georgia law, PART TWO generally will have no
force and effect if I am pregnant unless the fetus is not viable and I indicate
by initialing below that I want PART TWO to be carried out.
_________ (Initials) I want PART TWO to be carried out if my fetus is not