Here is a document about CHOICES in the event of severe novel coronavirus illness. Think it over carefully. It is not legally enforceable, but might be a useful guide to hospital staffs.

April 2020
My Choices If I Become Sick
in the COVID Pandemic

? Choose only one in each group of three.
Location

? MEDICAL FACILITY: I want to be transferred to a medical facility as soon as my symptoms
are not easily managed at home.

? IT DEPENDS: I want to stay at home unless my symptoms cannot be adequately managed at
home, in which case I want to be transferred to a medical facility.

? HOME: I want to stay at home, if possible, even if my distress becomes considerable.

Symptom Management

? LOW: I want minimal sedation and want to be clear and conscious as long as possible.

? MEDIUM: I want adequate sedation but would like to be clear and conscious enough to
communicate if possible.

? HIGH: I want maximum treatment of my symptoms, including pain, and understand this
might hasten my death.

Life Support Machines (Including Ventilators)

If I become sick enough to need a life support machine…

? YES: I want to be on a life support machine if one is available.

? MAYBE: I would prefer to be on a life support machine, but do not want to be put on a life
support machine if there are others who are more likely to survive who need it.

? NO: I do not want to be put on a life support machine even if one is available.

Name (printed): Signature:
Date:

Tags: choice in dying, Death With Dignity, Euthanasia, Final Exit, right to die, Self-Deliverance