Medical Power of Attorney and Medical Directions for End-of-Life

Medical-Power-Of-Attorney.txt.asc

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DURABLE POWER OF ATTORNEY FOR HEALTH CARE

I, David Quintyn Mertz, of 45 Main Street, Dexter ME 04930 USA, being of sound
mind, voluntarily create this Durable Power of Attorney for Health Care.


PRIOR DESIGNATIONS

I revoke any prior Durable Power of Attorney for Health Care.


APPOINTMENT OF HEALTH CARE AGENT

In the event that I have been determined to be incapable of providing informed
consent for medical treatment and surgical and diagnostic procedures, I wish to
designate as my agent for health care decisions:

    Lisa Constant
    930 Koae St
    Honolulu HI 96816 
    Telephone: 808-726-5155 
    Relationship: Sister


APPOINTMENT OF ALTERNATE HEALTH CARE AGENT

If I revoke Lisa Constant's authority or if Lisa Constant is not willing, able,
or reasonably available to make a health care decision for me, I designate as
my alternate agent:

    Mary Ann Sushinsky
    45 Main Street
    Dexter ME 04930
    Telephone: (323) 898-4444
    Relationship: Partner


AGENT'S AUTHORITY

My agent is authorized to act for me in all matters relating to my health care.
My agent's powers include, but are not limited to:

 * Full power to consent, refuse consent, or withdraw consent to all medical,
 surgical, hospital and related health care treatments and procedures on my
 behalf, according to my wishes as stated in this document, or as stated in a
 separate Living Will, Health Care Directive, or other similar type document,
 or as expressed to my agent by me;

 * Full power to make decisions on whether to provide, withhold, or withdraw
 artificial nutrition and hydration on my behalf, according to my wishes as
 stated in this document, or as stated in a separate Living Will, Health Care
 Directive, or other similar type document, or as expressed to my agent by me;

 * Full power to review and receive any information regarding my physical or
 mental health, including medical and hospital records, in accordance with the
 Health Insurance Portability and Accountability Act of 1996, 42 USC 1320d
 ("HIPAA"), and the American Recovery and Reinvestment Act of 2009 ("ARRA");

 * Full power to sign any releases in order to obtain this information;

 * Full power to sign any documents required to request, withdraw, or refuse
 treatment or to be released or transferred to another medical facility.

My agent does not have authority to act for me for any other purpose unrelated
to my health care. All of my agent's actions under this power during any period
when I am unable to make or communicate health care decisions have the same
effect on my heirs, devisees and personal representatives as if I were
competent and acting for myself.


WHEN AGENT'S AUTHORITY BECOMES EFFECTIVE

The designation of my health care agent will become effective on my inability
to make or communicate health care decisions as determined by my attending
physician and will remain in effect until my death, or until I regain
competence and revoke it.


AGENT'S OBLIGATIONS

My agent will make health care decisions for me in accordance with this
document, and in accordance with any instructions I give in a Living Will,
Health Care Directive or other such document (either included in this document
or as a separate document), and my other wishes to the extent known to my
agent. To the extent my wishes are unknown, my agent will make health care
decisions for me in accordance with what my agent determines to be in my best
interest. In determining my best interest, my agent will consider my personal
values to the extent known to my agent.


NOMINATION OF CONSERVATOR OR GUARDIAN

If a conservator or guardian of my person needs to be appointed for me by a
court, I nominate Alessandra Smith, the agent designated in this form. If
Alessandra Smith is not willing, able, or reasonably available to act as
conservator, I nominate Mary Ann Sushinsky, the alternate agent designated in
this form. My nominated conservator or guardian is not required to post bond or
security.


EFFECT OF COPY

A copy of this Durable Power of Attorney for Health Care has the same effect as
the original.


SEVERABILITY

If any part or parts of this Durable Power of Attorney for Health Care is found
to be invalid or illegal under applicable law by a court of competent
jurisdiction, the invalidity or illegality of such part or parts shall not in
any way affect the remaining parts, and this document shall be construed as
though the invalid or illegal part or parts had never been included herein. But
if the intent of this Durable Power of Attorney for Health Care would be
defeated by such construction, then it shall not be so construed.


SIGNATURE

This Durable Power of Attorney for Health Care is made after careful
reflection, while I am of sound mind. I am fully informed as to all contents of
this document and understand the full import of this grant of powers to my
agent. I fully understand that by signing this document, I will permit my agent
to make health care decisions for me.  I understand that my signature on this
document gives my agent authority to provide, withhold, or withdraw consent to
health care treatments or procedures on my behalf; to apply for public benefits
to defray the cost of my health care; and to authorize my admission to or
transfer from a health care facility. I further affirm that I am not signing
this document as a condition of treatment or admission to a health care
facility.

Signature:

_________________________

Name:

David Quintyn Mertz

Date:

____________________

Place:

Dexter Maine


++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++


INSTRUCTIONS FOR HEALTH CARE

If I, David Quintyn Mertz, become incapacitated and am unable to direct my
health care providers as to my own health care, I direct that this statement be
read as a true reflection of my health care wishes.

DEFINITIONS

For the purposes of this document, the following definitions apply:

1. "Artificially administered food and water" (or artificial nutrition
   and hydration) means the provision of nutrients or fluids by a tube
   inserted in vein, under the skin in the subcutaneous tissues, or in
   the stomach (gastrointestinal tract).

2. "Attending physician" means the physician licensed by the state
   board of medicine, selected by or assigned to the patient, and who
   has primary responsibility for the treatment and care of the
   patient.

3. "Comfort care" means treatment, including prescription medication,
   provided to the patient for the sole purpose of alleviating pain.
   Artificially administered food and water is not included.

4. "Health care provider" or "provider" means any person licensed,
   certified, or otherwise authorized by law to administer health care
   in the ordinary course of business or practice of a profession.

5. "Irreversible (Permanent) Coma" means a profound state of
   unconsciousness caused by disease, injury, poison, or other means
   and for which it has been determined that there exists no
   reasonable expectation of regaining consciousness.

6. "Life-prolonging procedure" (or "life-sustaining procedure") means
   any medical procedure, treatment, or intervention which sustains,
   restores, or supplants a spontaneous vital function. In this
   document the term does not include sustenance and hydration
   administration, or the provision of medication or the performance
   of medical procedure, when such medication or procedure is deemed
   necessary to provide comfort care or to alleviate pain.

7. "Persistent vegetative state" means a permanent and irreversible
   condition in which there is:
         a. The absence of voluntary action or cognitive behavior of
            any kind.
         b. An inability to communicate or interact purposefully with
            the environment.

8. "Terminal condition" means a condition caused by injury, disease,
   or illness from which there is no reasonable medical probability of
   recovery and which, without treatment, can be expected to cause
   death.

MEDICAL DIRECTIONS AND END-OF-LIFE DECISIONS

I direct that my health care providers and others involved in my care, provide,
  withhold, or withdraw treatment in accordance with my directions below:
(Review and initial where indicated)

1. If I have an incurable and irreversible (terminal) condition that
   will result in my death within a relatively short time, I direct
   that:
      + I be removed from any artificial life support or any
        additional life-prolonging treatment. ______ (my initials)
      + I not be artificially administered food and water, realizing
        this may hasten my death. ______ (my initials)
      + I be provided comfort care, and relief from pain, including
        any pain reduction medication, even if doing so would prolong
        my life.

2. If I am diagnosed as being in an irreversible coma and, to a
   reasonable degree of medical certainty, I will not regain
   consciousness, I direct that
      + I be removed from any artificial life support or any
        additional life-prolonging treatment.  ______ (my initials)
      + I not be artificially administered food and water, realizing
        this may hasten my death.  ______ (my initials)
      + I not be provided any comfort care, and relief from pain,
        including any pain reduction medication, if the effect would
        be to prolong my life.  ______ (my initials)

3. If I am diagnosed as being in a persistent vegetative state and, to
   a reasonable degree of medical certainty, I will not regain
   consciousness, I direct that:
      + I be removed from any artificial life support or any
        additional life-prolonging treatment.  ______ (my initials)
      + I not be artificially administered food and water, realizing
        this may hasten my death.  ______ (my initials)
      + I not be provided any comfort care, and relief from pain,
        including any pain reduction medication, if the effect would
        be to prolong my life. ______ (my initials)


ADDITIONAL INSTRUCTIONS

I direct that my body not be buried in Utah.  And don't mourn, organize. I
understand that I may change the above-listed directives at any time by
revoking this declaration and writing a new one.


EFFECT OF COPY

A copy of this Instructions for Health Care has the same effect as the
original.


SEVERABILITY

If any part or parts of this Instructions for Health Care is found to
be invalid or illegal under applicable law by a court of competent
jurisdiction, the invalidity or illegality of such part or parts shall
not in any way affect the remaining parts, and this document shall be
construed as though the invalid or illegal part or parts had never been
included herein. But if the intent of this Instructions for Health Care
would be defeated by such construction, then it shall not be so
construed.

SIGNATURE

This document is made upon careful reflection. Options that I have considered
and rejected are not printed above. I confirm that the health care directions
contained herein were made after careful consideration and in full awareness of
other options that may have been available to me. I declare that I am an adult
in the State of California, that I understand the full import of this
declaration, and that I am emotionally and mentally competent to give these
directions.

Signed at Dexter, in the State of Maine, this 15th Day of January, 2020.

Signature:

_________________________

Name:

David Quintyn Mertz

Address:

45 Main Street
Dexter ME 04930 USA
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