E. This directive will be IN EFFECT when, and only when, I am unable to make or
communicate my own decisions by speaking, writing or gesturing.
F. If my spouse has been designated as an Agent or Alternative Agent in this document
and if after the making of this document my spouse and I become legally separated or
divorced, any legal rights or powers granted to my spouse by this document shall be
revoked.
G. Any reference to Agent in this document shall also apply to an Alternative Agent.
H. I grant to my Agent the absolute power and authority to make all decisions affecting
my health and welfare, and request that my Agent and all to whom he/she shall give
directions in these matters follow my wishes and instructions as given herein to the
best of my Agent’s interpretation of my wishes. In particular, but not restricted to, I
grant to my Agent the power and authority to: sign documents including releases,
permissions, or waivers; to review and disclose medical records; to hire and discharge
caregivers; to authorize admission to or release from medical facilities; and to consent
to, refuse or withdraw consent to any form of health care.
I. It is MY WISH that should a situation arise that there is no reasonable expectation of
my recovery and I am being kept alive by artificial or mechanical means, that ______
_____________________________________________________________________
_____________________________________________________________________
_____________________________________________________________________
_____________________________________________________________________
_____________________________________________________________________
_____________________________________________________________________
____________________________________________________________________ .
J. If it becomes necessary to appoint a Guardian of my person then I nominate my
Agent who is appointed in this document to be my Guardian.
The Canadian Financial Security Program - LW