162A.860. Power of attorney: Form, NV ST 162A.860
6. STATEMENT OF DESIRES.
(With respect to decisions to withhold or withdraw life-su staining treatment, your agent must make health care decisions that
are consistent with your known desires. You can, but are not required to, indicate your desires below. If your desires are
unknown, your agent has the duty to act in your best interests; and, under some circumstances, a judicial proceeding may be
necessary so that a court ca n determine the health care decision that is in your best interests. If you wish t o indicate your desires,
you may INITIAL the statement or statements that reflect your desires and/or write your own statements in the space below.)
(If the statement reflects your desires, initial the box next to the statement.)
1. I desire that my life be prolonged to the greatest extent possible,
without regard to my condition, the chances I have for recovery or long-
term survival, or the cost of the procedures.
2. If I am in a coma which my doctors have reasonably concluded is
irreversible, I desire that life-sustaining or prolonging treatments not be
used. (Also should utilize provisions of NRS 449.535 to 449.690,
inclusive, if this subparagraph is initialed.)
3. If I have an incurable or terminal condition or illness and no
reasonable hope of long-term recovery or survival, I desire that lif e-
sustaining or prolonging treatments not be used. (Also should utilize
provisions of NRS 449.535 to 449.690, inclusive, if this subparagraph is
4. Withholding or withdrawal of artificial nutrition and hydration may
result in death by starvation or dehydration. I want to receive or continue
receiving artificial nutrition and hydration by way of the gastrointestinal
tract after all other treatment is withheld.
5. I do not desire treatment to be provided and/or conti n ued if the
burdens of the treatment outweigh the expected benefits. My agent is to
consider the relief of suffering, the preservation or restorat ion of
functioning, and the quality as well as the extent of the possible
extension of my life.
(If you wish to change your answ er, you may do so by drawing an “X” through the answer you do no t want, and circling the
answer you prefer.)
Other or Additional Statements of Desires:
7. DESIGNAT IO N OF ALT ERNATE AGE NT.
(You are not required to designate any alternative agent but you may do so. Any alternative agent you designate will be able to
make the same health care decisions as the agent designated in paragraph 1, page 2, in the event that he or she is unable or
unwilling to act as your agent. Also, if the agent designated in paragraph 1 is your spouse, his or her designation as your agent
is automatically revoked by law if your marriage is dissolved.)
If the person designated in paragraph 1 as my agent is unable to m ake health care decisions for me, then I designate the following
persons to serve as my agent to make health care decisions for me as authorized in this document, such persons to serve in the
order listed below: