Sample -1
It is to bring to your kind attention that I Mr. Louis Henry, holding CNIC no [X] is suffering from a prolonged disease of kidneys for two years. I hereby certify that I am conscious and can make medical decisions for myself. However, my physician and I mutually agree that I will not be able to take the medical decision for myself in the long run.
Therefore, I hereby nominate Mr. Joshua Hills, holding CNIC no [X] as my attorney for medical treatment under the following conditions:
- I hereby declare Mr. Joshua as my attorney for medical decisions. However, this attorney will only be validated when I am incapacitated and not able to decide for myself.
- Mr. Joshua will be referred to my agent from now onwards.
- To make this power of attorney effective, my agent needs a certificate from any certified physician stating that I am incapacitated and cannot make medical decisions on my own.
- This power of attorney can only be revoked by me.
- I endorse those medical decisions will be taken by my agent on my behalf and my family members and relatives have no right to question the judgment of my agent.
- My agent is the sole authority to make decisions on my behalf and my stead however, he may take advice and help from other physicians to facilitate himself in making the right decision.
- My agent can have access to all my medical records, my medical history, medical reports and other data related to my medical proceeding.
- My agent can also decide to end my life in case of irreversible coma, untreatable illness, a bedridden situation where no cure is possible.
I declare that I am giving my medical power of attorney to my agent willingly without any pressure or force. I have already discussed my case and my medical priorities with my agent and finds him compatible enough to carry out the task. I have attached to necessary documents with my letter. In case of further assistance, you may contact the following number [x]. Thanking in anticipation.
Regards,
Sample -2
I am writing to inform you that I Shawn Mishak, Holding CNIC No. [X] am willingly transferring the rights of medical power of attorney to Mr. Mike Angelo, holding CNIC no [x] due to my medical condition. Right now, I am fully conscious and can make decisions related to my medical issues, myself but my doctors are telling me that in the long run, I will not be able to do so as I have a severe brain disease. This condition can paralyze me in the future. It can also erase my memory. I think it is the right time to make this decision consciously.
I, therefore, make Mr. Mike Angelo my medical attorney on the following terms.
- My agents hold the complete right to make a decision on my behalf and to change the doctor and treatment if needed.
- In case my agent dies, or resign, I nominate Sean Castel as his successor.
- My agent can decide to end my life if I will be living on machines.
I have already discussed my case with my agent and he knows what do to in certain situations. He is also competent enough to make the right decisions on my behalf and stead when I will be incapacitated. I have attached the necessary documents with this letter to support this legal right of mine. In case you need any further information kindly contact me on my number [X]. Thanking you in advance.
Regards,
