Nevada § 449A.439 - Form of declaration designating another person to decide to withhold or withdraw life-sustaining treatment

§ 449A.439. Form of declaration designating another person to decide to withhold or withdraw life-sustaining treatment

1. A declaration that designates another person to make decisions governing the withholding

or withdrawal of life-sustaining treatment may, but need not, be in the following

form: DECLARATION If I should have an incurable and irreversible condition that, without the administration

of life-sustaining treatment, will, in the opinion of my attending physician or attending

advanced practice registered nurse, cause my death within a relatively short time,

and I am no longer able to make decisions regarding my medical treatment, I appoint

__________ or, if he or she is not reasonably available or is unwilling to serve, __________, to make decisions on my behalf regarding withholding or withdrawal of treatment

that only prolongs the process of dying and is not necessary for my comfort or to

alleviate pain, pursuant to NRS 449A.400 to 449A.481 , inclusive. (If the person or persons I have so appointed are not reasonably available or are

unwilling to serve, I direct my attending physician or attending advanced practice

registered nurse, pursuant to those sections, to withhold or withdraw treatment that

only prolongs the process of dying and is not necessary for my comfort or to alleviate

pain.) Strike language in parentheses if you do not desire it. If you wish to include this statement in this declaration, you must INITIAL the statement

in the box provided: Withholding or withdrawal of artificial nutrition and hydration may result in death

by starvation or dehydration. Initial this box if you want to receive or continue

receiving artificial nutrition and hydration by way of the gastrointestinal tract

after all other treatment is withheld pursuant to this declaration. [____________________] Signed this _______________ day of __________, ______ Signature _____________________________________ Address _______________________________________ The declarant voluntarily signed this writing in my presence. Witness _______________________________________ Address _______________________________________ Witness _______________________________________ Address _______________________________________ Name and address of each designee. Name __________________________________________ Address _______________________________________ 2. The designation of an agent pursuant to chapter 162A of NRS , or the judicial appointment of a guardian, who is authorized to make decisions regarding

the withholding or withdrawal of life-sustaining treatment, constitutes for the purpose

of NRS 449A.400 to 449A.481 , inclusive, a declaration designating another person to act for the declarant pursuant

to subsection 1.