I, the owner of the pet(s) identified above, certify that I am over eighteen years of age and make this statement as a directive to be followed if, for any reason, I become unable to participate in the decisions regarding the medical care of my pet. I direct that if, in the opinion of the attending veterinarian, my pet’s condition becomes such that:
- My pet is in the terminal stage of an irreversibly fatal illness, disease or condition, or death is imminent; or
- My pet is in a state of permanent unconsciousness; or
- My pet is suffering and it would be inhumane to keep my pet alive; or
- There is no reasonable expectation that my pet will recover and regain an acceptable quality of life
Further treatment by life-sustaining procedures, methods, and devices involving further emergency or therapeutic care be withheld and withdrawn. I further direct that all treatments be limited to comfort and pain management measures only, even if they shorten my pet’s life.
The life-sustaining procedures, methods, devices, and therapeutic or emergency care that shall be withheld and withdrawn, include, without limitation, surgery, antibiotics, cardiopulmonary resuscitation, respiratory support, life-sustaining treatment, and artificially administration feeding and fluids.