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06-07 C. Other formalities 1. Insurance 2. Last Will & execution of the Last Will 3. Formalities in the Netherlands

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What to do when a Dutch expat passes away in Thailand, in particular in or near Pattaya? No matter how prepared we may be, the passing away of a loved-one is always a matter of great grief and sadness. Below is a description of the process to deal with the physical and – especially – administrative details. The process is relatively simple & straightforward, but it takes time and expenses. The consular section of the Netherlands Embassy in Bangkok may advise you to make use of a professional undertaker, but these services are costly. In most cases you can handle it yourself; this includes 2 trips to Bangkok. The rules of the Thai government (Police, City Hall) for documentation have recently been updated and have been made more formal and correct. This procedure is written for when a Dutch expat passes away at home; there are additional chapters for other possibilities.

Page Subject

02-05 A. Passing away at home

1. Passing away at home & reporting to the nearest police station

2. Transport of the body to the Forensic Department of the Police Hospital in Bangkok 3. Reporting to the Netherlands Embassy in Bangkok

4. Initial (handwritten) police report

5. Initial contact with the temple or church for the cremation or burial 6. Autopsy report of the Police Hospital

7. Final Pattaya Police report

8. Death certificate of Pattaya City Hall

9. Contact with the embassy for transport of the body and final arrangements for the cremation or burial 10. Pre-arrange the transport from Bangkok to Pattaya; the coffin; notification of the temple or church 11. The Release Document of the Netherlands Embassy in Bangkok; clothing for the deceased

12. Collecting the body at the Police Hospital in Bangkok and transport of the body to Pattaya 13. Cremation or burial and further rituals

05 B. Other possibilities

1. Passing away in a Private Hospital 2. Passing away outside the home 3. Passing away in a government hospital 4. Transport of the body to the Netherlands 06-07 C. Other formalities

1. Insurance

2. Last Will & execution of the Last Will 3. Formalities in the Netherlands

07-09 D. Attachments 1. Summary of documents

2. Summary of useful names & addresses 3. Euthanasia

4. Living will for medical treatment in Thailand

PLEASE NOTE: Like all regulations, this procedure is subject to changes, but the basic steps as described will remain. It is best to ask authorities at every step what the next step is, but be careful: not all may be aware of the full procedure!

For comments or additions, please send email to [email protected]

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Please Note: This procedure is written for the case of a Dutch expat passing away at home and that body of the deceased will be cremated or buried in Thailand. Also assumed is that the cost of this will be paid by family of the deceased in the Netherlands (you need to make prior arrangements for this with this family), or by friends in Thailand.

General advice

Make copies (scans are even better) of the passport of the deceased, the initial (handwritten) police report, the autopsy report of the Police Hospital in Bangkok, the final (typed) police report, the death certificate of Pattaya City Hall (most important), and the certified translation in English of the death certificate (also very important). You will need some or all of these documents for further actions.

Listing the exact name of the deceased in documents is very important. Use always first the family name, then a comma and then the given names – exactly the same as in the passport. Always use CAPITAL letters, and verify the spelling as Thai civil servants often make spelling mistakes. Make sure that the Thai transliteration of the Dutch names is always the same (e.g. on the Death Certificate).

You must go to Bangkok twice. The first time only to pick up the Autopsy Report of the Forensic Institute of the Police Hospital on Henri Dunant Road (near Siam Square). The second time to pick up the Release Document at the Netherlands Embassy in Soi Thonson on Ploenchit Road, directly followed by collecting the body at the Forensic Institute (with a Sawang Booriboon Rescue Team).

As parking is difficult, I suggest to park your car in a parking garage and do the rest by taxi. On the second trip, let the taxi wait at the embassy before going to the Forensic Institute.

A. Passing away at home

1. Passing away at home & reporting to the nearest police station

After you or a doctor have noticed the death, contact the nearest Police Station as soon as possible. The police will come to verify the death and to make an initial assessment that no crime was committed (If a crime is suspected, then a forensic team will be called.) The police officer collects witness reports and pictures. Ask for the name & contact details (mobile number) of the officer.

The officer will request the passport of the deceased (it is best to make scans or copies first) and will make an initial (preliminary) handwritten Police Report (free). For collection of this report see chapter 4. 2. Transport of the body to the Forensic Department of the Police Hospital in Bangkok

After the visit of the police, the body of any foreigner passing away at home must be transported for autopsy (to determine the cause of death) to the Forensic Institute of the Police Hospital in Bangkok at Henri Dunant Road; the autopsy is usually done within 48 hours.

The local police will arrange this transport, usually through the services of the local Sawang Booriboon Foundation. In some instances the body may be transported first to the nearest government hospital (Banglamung Hospital). A donation of several thousand of Baht is requested/required for the transport. 3. Reporting to the Netherlands Embassy in Bangkok

Regardless of where the person has died, the consular section of the Dutch Embassy must be notified as soon as possible telephone 02 309 5200 e-mail [email protected] The consular section can also help you with any questions. Make sure that you have the passport details of the deceased, and details of the family in the Netherlands plus telephone numbers. The embassy needs a scanned copy (‘picture’ page only), and (later) also of the initial, handwritten police report. Also a scan of your passport, as your name will be used later in the Release Document of the embassy that is needed to collect the body at the Police Hospital. Immediate notification of the embassy is required because they must contact the family of the deceased in the Netherlands (via the Dutch Ministry of Foreign Affairs). As a result of the time difference and day of the week, this may take some time. The family needs to give permission for the cremation or burial in Thailand (they do not claim the body for cremation or burial in the Netherlands).

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When the body is not claimed by the family, then this is reported to the embassy in Bangkok, and it allows the embassy to prepare the Release Document (with your name in it) that is needed for the Forensic Department of the Police Hospital to collect the body for cremation or burial.

Please note:

When there are no Thai or Dutch family members or others who will take care of the workload and cost of the disposal of the body, then all will be arranged by the embassy, but the embassy may request your cooperation.

When the family in the Netherlands claims the body for cremation or burial in the Netherlands, then your involvement basically ends, and the family should take care of all other matters & the considerable cost. Of course, you may choose to assist the family as much as you can.

4. Initial (handwritten) Police Report

An initial (preliminary) handwritten Police Report (free) can be picked up at the police station on the same of the visit of the police officer, or on the next day. Make sure that the name of the deceased is spelled correctly = exactly as in the passport! Make copies or a scan (better) of the report, and, if not yet done, make several good copies of the passport of the deceased (scans are even better). Do not forget to ask for the return of the passport!

5. Initial contact with the temple or church for the cremation or burial

Go to the temple or church to prepare the cremation or burial. The temple or church has a ‘master of ceremonies’ to make cremation/funeral arrangements. Ask for the cost; there are always many options. Prices differ per temple/church; the most simple temple cremation ceremony currently costs around 20,000 Baht. There are also different options for the disposal of the ashes/storage of the urn or for burial. The body will be delivered in a casket. Do not specify an exact date of delivery. Write down the exact name and address of the temple or church (you will need this later at the Police Hospital and at City Hall). Also write down the name & mobile number of the ‘master of ceremonies’.

6. Autopsy report of the Police Hospital

This report is usually available within 48 hours after delivery of the body.It states the cause of death as found at the autopsy.In case of doubt on when the report is available, then contact the embassy who then will contact the Police Hospital. You need to collect this report (DIN A5 format) personally at the Forensic Institute of the Police Hospital on Henri Dunant Road, close to Siam Square. You must pay for the report (at present 2,000 Baht). Make copies or a scan of the autopsy report!

Take the initial (handwritten) Pattaya police report with you for case number, the passport of the deceased and your own passport, plus the exact name of the temple or church where the body will be cremated or buried. This is needed for a document that you do not receive; it lists the name of the

collector of the body and the place of cremation or burial. Make sure that you have a Thai helper with you as not everyone speaks English!

The body will only be released to you at a second visit to the Forensic Institute when you present:

 The Death Certificate of Pattaya City Hall (see further)

 The Release Document (in your name) of the Netherlands Embassy (see further) 7. Final Pattaya Police Report

You receive this typed report (free) at the Pattaya police station after presenting the autopsy report as mentioned above. Make sure that the name of the deceased is spelled correctly = exactly as in the passport! Also bring the passport of the deceased and you passport. You need the typed police report for City Hall, see next chapter. Make sure you get the original autopsy report back. You may have to wait a few hours before the report is ready ….

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8. The Death Certificate of Pattaya City Hall

Go to the ‘one-stop service center’ on the 2nd floor of Pattaya City Hall on North Pattaya Road and request a death certificate. This (free) certificate is made immediately; you must sign the original. The certificate is one of the two vital documents that you need to collect the body at the Forensic Institute in Bangkok. To get the Death Certificate you need to bring:

 Passports of the deceased and yourself

 The typed (final) report of Pattaya Police

 The autopsy report of the Police Hospital

Get a certified translation into English from a certified translator (see D-2f).

9. Contact the embassy for transport of the body & final arrangements for the cremation or burial You now have all the documents, except the Release Document of the Netherlands Embassy. The embassy can only give you this document after approval of the family in the Netherlands (see chapter 3). Contact the embassy and ask when the document is available.

10. Pre-arrange the transport from Bangkok to Pattaya; the coffin; notification of the temple or church This is the transport from the Forensic Institute in Bangkok to the temple or church in Pattaya. Do this with the Sawang Booriboon Foundation. Their office is in the entrance hall of their (Chinese) temple in Naklua. (Drive on Sukhumvit in the direction of Chonburi; after passing the foot bridge in Naklua, take the second road left. Follow the road, keep to the right, and you will see the arch of the Chinese temple, or ask around for ‘Wat Sawang Booriboon’.)

Pre-arrange the transport with them and make sure that the ‘Rescue’ car is at the Forensic Institute at 11:00 am on the day that you will specify later. You will be asked for a voluntary contribution; 1,500 Baht is enough. You must also arrange a casket. You can buy this yourself in Naklua on Sawang Fa Road, or let the driver do this. A simple white & gold casket is 3,500 Baht at present; make sure it is long enough for the body! Get mobile numbers & names. Make the final date arrangement as soon as you know when you can collect the Release Document at the Netherlands Embassy. You can collect the body the same day. Also notify the temple or church of this date.

11. The Release Document of the Netherlands Embassy in Bangkok; clothing for the deceased After the Netherlands Embassy tells you that the Release Document is available, notify the Sawang Booriboon Foundation. Go to Bangkok the next morning and be at the embassy (Soi Thonson, Ploenchit Road, close to Wittayu/Wireless Road) no later than 10:00 am. Mention the reason of your visit and you will be helped almost immediately. Also take a set of outer clothing of the deceased with you on that day. Show the embassy the following documentation:

 Your passport (your name is in the Release Document)

 The passport of the deceased (it will be invalidated before returning it to you)

 The Death Certificate from Pattaya City Hall

Make sure you get everything back, and check the Release Document (it is in Thai) if the correct names have been used. Now go directly to the Forensic Institute on Henri Dunant Road.

12. Collecting the body at the Police Hospital in Bangkok and transport of the body to Pattaya With (original & copy) the Death Certificate from Pattaya City Hall and the Release Document of the Netherlands Embassy, you can now collect the body of the deceased at the Forensic Institute. Call the Sawang Booriboon driver.

Wait for the arrival of the Sawang Booriboon’s Rescue car and then present the documents at the booth. You must sign a register. Provide the set of outer clothing to the Recue team to dress the body; the cost for this dressing has to be paid to employees of the Forensic Institute.

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The Rescue team takes care of this and the rest. They will ask for ‘a contribution to get the body released immediately and to dress the body’. Count on 2,000 Baht and add 1,000 Baht for the Rescue team (and mention this to them).

The body is then put into the casket, brought from Naklua (collect the receipt from the driver). The Rescue car goes immediately to the temple or church in Pattaya (arrival in about 2 hours). Notify the temple or church of the arrival time. Go to the temple or church and make a deposit, if not yet done.

Please note: The treatment of the body at the Forensic Institute is basic and correct, but may give outsiders the impression that it is without enough respect. You can arrange showing the body at the institute to flown-in family members. In that case, take clothing of the deceased with you, and first arrange that the body is cleansed & clothed by the staff of the institute

13. Cremation or burial and further rituals

Notify relatives & friends of the deceased of the date of the cremation or burial. Deliver as soon as possible a large framed photograph of the deceased (at least 21 x 30 cm/ letter size) to the temple or church. The ceremonies at the temple or church will be as earlier arranged by you.

B. Other possibilities

1. Passing away in a Private Hospital

This follows the basics of the process as described under A. However, the body will only be transported to the Forensic Institute after all bills have been paid or guaranteed by the insurance or family/friends. Unless specified differently by you, the transport to (& from?) Bangkok will be per (costly) hospital ambulance. 2. Passing away outside the home (e.g. traffic accident or crime)

This too follows the basics of the process as described under A. However, the body is first transported to Banglamung Hospital or to a Private Hospital; the police will decide this in your absence. In case of a suspected offense or crime, it may take some time before the body is released as the question of ‘guilt’ has to be addressed. You will find this out during your contacts with the police and/or at the autopsy process. 3. Passing away in a Government Hospital

This too follows the basics of the process as described under A. However, when the deceased has spent his/her final days in a government hospital, then the body is not transported to the Forensic Institute in Bangkok (except for unusual cases). The hospital will provide a report that is a combination of a police report and an autopsy report (around 2,000 Baht). You must go to City Hall within 24 hours to obtain a Death Certificate, and then go to the Netherlands Embassy for the Release Document that the hospital requires to release the body to you. Here too, you will get the body after all hospital bills have been paid or guaranteed by the insurance or family/friends.

4. Transport of the body to the Netherlands

The procedure for repatriation takes about one week. Consult with the embassy for qualified undertakers. To collect the body at the Forensic Institute, the undertaker requires the same documents: the Death Certificate from Pattaya City Hall and the Release Document of the Netherlands Embassy. Also required is a certified translation of the Death Certificate and a legalization of this translation by the Thai Ministry of Foreign Affairs, Consular Service on Chaeng Wattana Road in Bangkok. You may help with all of this (not costly), or leave all of it to the undertaker (costly). Make sure you get copies of all documents!

The undertaker carries out the embalming and provides a zinc casket, adds a Certificate of Embalming and arranges the air transport to & transport in the Netherlands. The total expense of repatriation of the body (inclusive air & local transport) is very substantial. You could also choose for a cremation in Thailand and sending the urn to the Netherlands for a fraction of the cost & complications.

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C. Other formalities

1. Insurance

Quite a few tourists (& expats) may have a travel insurance or health insurance that covers part (most) or all (seldom) of the cost of passing away. Some may even have a specific ‘death insurance’ (provide details of this in your last will). Contact the insurance in case you do not have details. If this is not immediately possible, then verify later; keep expenses at a modest level, and keep receipts of all expenses.

Repatriation of the body to the Netherlands is by far the most costly option. Some insurers cover these expenses, provided they are notified immediately; they may also determine which undertaker to use and which airline.

2. Last Will & execution of the Last Will

Keep in mind that all transactions that require the signature of the deceased are no longer possible. This seems obvious, but few of us consider this when we are alive, and this may have serious consequences for our Thai dependents (partner, staff). You should take this into consideration when making a Last Will. Also consult with your lawyer to see what can be done.

The release of possessions that are registered in the name of the deceased to the rightful heir(s) depends on whether or not a Last Will was made, and on the terms and conditions of the Last Will. This chapter will focus on a Thai Last Will. Without a Thai Last Will, Thai authorities (after a court decision, usually taking 3 months) will make decisions on all possessions that are in the name of the deceased, and this may cause problems for the remaining partner or dependents.

Making a Last Will in Thailand is easy: a document in any language or in Thai, signed by yourself and 2 witnesses is all that is needed. However, you should really use a reliable layer who is a Licensed Notary Public. This Notary Public will have standard examples and may help defining particular clauses. Also include what you want to have done with your body when you pass away. In any case you must appoint an Executor of your estate (can be your partner). If you make your own Last Will in Dutch or English (both not advisable), then the court requires a certified translation into Thai.

When there is a recognized partner, then a ‘Will on the Last-Living’ is appropriate. This must specify that the partner can make use of bank accounts, the house/apartment, car, etc. It is best to make the partner the Executor of the estate.

A Dutch (or other Non-Thai) Last will can also be used, but it requires a certified translation into (English and) Thai. We suggest making a certified translation of a Dutch will into English in the Netherlands, and a certified translation into Thai at a reputable certified translator in Thailand.

Always carry your own name and of your partner or a good friend with you. This enables contacting others in case of an accident. Keys, safe code, pin codes, and computer access codes should be left (for instance in a sealed envelope).

Always make sure that the name(s) in any document is (are) spelled correctly and in line with the name(s) as mentioned in the passport(s)! Mistakes are often made, also at lawyer offices, and there may be complications when this simple rule is not followed. This also goes for the Thai translation of the foreign names: make sure they are always the same!

3. Formalities in the Netherlands

The death of a Dutch citizen must be reported as soon as possible to various organizations, such as:

 The Civil Administration of the city of which the deceased was a resident. If the deceased is no longer registered in the Netherlands (= emigrated to Thailand), go to the website of Gemeente Den Haag to download a notification document: www.denhaag.nl/Buitenlandse-huwelijksakte-inschrijven.htm (the link mentions ‘marriage certificate’ but the form is also used for the death certificate). Any questions: contact the Netherlands Embassy.

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 Pension fund companies (private & state pension authority SVB), life insurance companies

 Medical insurance company

 Bank(s)

 Tax authority (Internal Revenue Service)

 Former employer(s)

 Etc.

Check the deceased’s records (and wallet) to see if other organizations need to be informed. Make sure that you have the deceased’s civil service number (‘burgerservicenummer’ or BSN) as this is needed for nearly all correspondence. It should be mentioned in the passport (but is not always).

The best way is to send such organizations a formal letter (or e-mail) that includes the Death Certificate, a certified English translation of the Death Certificate and a copy of the (invalidated) passport.

Execution of the estate in the Netherlands (if any), may require that the Death Certificate – already translated into English by a certified translator – is legalized by the embassy or the Dutch Ministry of Foreign Affairs (ask the embassy for instructions).

D. Attachments

1. Summary of documents

The following documents are important:

a) Passport of the deceased: Required to obtain all other important documents and notifications. Make copies immediately as the passport will be invalidated by the Dutch Embassy by punching big holes in it that make reading difficult. Readable copies may be necessary later for (for instance) court cases in Thailand or in the Netherlands in relation to the execution of the Last Will.

b) Initial (handwritten) Police Report: Available the same or the next day at the police station where the death was reported. Required for the Police Hospital (the police will send that themselves) and the Netherlands Embassy. Make copies or scan!

c) Autopsy report of the Forensic Institute of the Police General Hospital in Bangkok: Required to obtain (1) the Final (typed) Police Report and (2) the Death Certificate from Pattaya City Hall. May also be asked by other authorities and for execution of the Last Will in the Netherlands (in that case you also need a certified & legalized translation). Make copies or scan!

d) Final (typed) Police Report: Available from the police station where the death was reported. To get this, you must have the Autopsy Report from of the Forensic Institute of the Police General Hospital in Bangkok. Make copies or scan.

e) Death Certificate from Pattaya City Hall. You will only get this when you have (1) the Final (typed) Police Report and (2) the Autopsy Report. Make copies and have it translated into English by a certified translator (make copies of this). Needed for various notifications.

f) Certified translation into English of the Death Certificate: A certified translation can only be made by a certified translator. A certified translation is required for all notifications to Non-Thai authorities or organizations. Make copies and scan!

g) Release Document: Is issued by the Netherlands Embassy in Bangkok and is needed to collect the body at the Forensic Institute and for international transport of the body.

h) Last Will: Having a proper Last Will facilitates the settlement of the estate, and provides security to your partner and other dependents. It is best to make one in Thailand, and do so through the service of a reputable Certified Notary Public. Leave a copy with your partner or a trusted friend!

Legalization of documents may be required for important legal transactions, such as the execution of the estate in the Netherlands (or in Thailand). Legalization of English translations of Thai documents gives the English translation the same legal status as the original Thai document. Is done at the Department of Consular Affairs of the Thai Ministry of Foreign Affairs. In the Netherlands, the Thai Embassy in The Hague can do this. May be required for the certified-translated Death Certificate and the certified-translated Autopsy Report.

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2. Summary of useful names & addresses

a) Pattaya City Hall

North Pattaya Road (between 3r & 2nd Road) Go to the ‘one-stop-service-center’ on their second floor

b) Royal Netherlands Embassy 15 Soi Tonson, Ploenchit Road (not far from the intersection with Wittayu/Wireless Road)

Lumpini, Pathumwan, Bangkok 10330 Tel: +66 (0)2 309 5200

Fax +66 (0)2 309 5205

E-mail: [email protected] The embassy has a 24-hour hot-line for very urgent matters (= not for deaths): 01-8414615

c) Police General Hospital in Bangkok (The Forensic Institute is on Henri Dunant Road, close to Rama I Road/Siam Square)

492/1 Rama I Road,

Patumwan, Bangkok, 10330

Tel. 02 2528111-5 en 02 2512925-7

d) Thai Ministry of Foreign Affairs, Department of Consular Affairs

(for legalizations of certified English translations of Thai documents) 123 Chaeng Watthana Road, Pakkret

Bangkok 10120 (a main side street of Viphavadi Rangsit Road, not far from Don Muang) Tel: 0-2575-1056-59 Fax: 0-2575-1054

Service hours: 08.30 - 14.30 hrs. (Closed Saturday, Sunday, Public Holidays) Email: [email protected]

If you do not yet have a certified translation of a Thai document in English, then you will find many open-air translators in the Soi at the right of the building. They charge the same as in Pattaya. For a fee, their services can usually also be used to get the document legalized without you waiting for it.

e) Undertaker in Thailand for transport of the body to the Netherlands Ask the Consular Section of the Dutch Embassy in Bangkok.

f) Lawyers & certified translators in Pattaya (a selection only of several options):

Law Office in Pattaya Jural Law Office, Mr Premprecha Dibbayawan (he is a Certified Notary Public van het Ministry of

Justice), 62/292-293 Thepprasit Road, Pattaya, in the back of the orange & green shop houses; enter either in the middle of the shop houses and turn left, or enter via Soi 6 and turn left. The office is at the

end of the road. Tel. 038 488 870 through 73 Fax 038 417 260 Email: [email protected]

Law Office in Pattaya Miss Choolada Sae-Lau

437/112-3 Yodsak Centre, Soi 6 Pattaya Beach Road, Pattaya City Tel 038 429343

Fax 038 423649

Certified translations in Pattaya

Lawyer Mr Premprecha Dibbayawan is a Registered-Qualified Translator for the Ministry of Justice 62/292-293 Thepprasit Road, Pattaya, in the back of the orange & green shop houses; enter either in

the middle of the shop houses and turn left, or enter via Soi 6 and turn left. The office is at the end of

the road. Tel. 038 488 870 through 73 Fax 038 417 260 Email: [email protected]

3. Euthanasia

Thai law does not have provisions for euthanasia, nor does it recognize euthanasia codicils made in the Netherlands or elsewhere. However, the Thai National Health Act, Art. 12, Part 1, dated 20 March 2550 makes it possible to limit the extent of ‘medical help at all costs’. See attachment for the Living Will that can be made. Hospitals are not obliged to accept this Living Will, so ask first and do not take matters into your own hands! In the worst case arrange transport of the ill patient to the Netherlands, or go to a ‘friendly’ Thai hospital (ask first).

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LIVING WILL FOR MEDICAL TREATMENT

In accordance with the Thai National Health Act, Art. 12, Part 1, dated 20 March 2550

Patient Name: ...

Hospital ID number: ……...

Address:...

Passport Number: ... Phone: ... E-mail address: ...

Being of sound mind and understanding all the implications, I ask that this document be brought

to the attention of any medical facility in whose care I happen to be, and to any person who may

become responsible for my affairs. This is my 'Living Will' stating my wishes in that my life should

not be artificially prolonged, if this sacrifices my Quality of Life.

If, for any reason, I am diagnosed as being in a terminal condition, I wish that my treatment be

designed to keep me comfortable and to relieve pain, and allow me to die as naturally as

possible, with as much dignity as can be maintained under the circumstances. As well as the

situation in which I have been diagnosed as being in a terminal condition, these instructions will

apply to situations of permanently unconscious states and irreversible brain damage.

In the case of a life-threatening condition, in which I am unconscious or otherwise unable to

express my wishes, I hereby advise that I do not want to be kept alive on a life support system,

nor do I authorize, or give my consent to procedures being carried out which would compromise

any Quality of Life that I might expect in the future.

I ask that you are sensitive to and respectful of my wishes; and use the most appropriate

measures that are consistent with my choices and encompass alleviation of pain and other

physical symptoms; without attempting to prolong life. Being of sound mind at the time of

making this declaration, I ask that you will follow my wishes. It is my conviction that Quality of

Life must be the main consideration for all decisions, not length of life.

In witness hereof, I have signed this document, which has also been signed by two witnesses,

who have read and understand my wishes.

So declared by me, signature: ………...

Signatures witnesses: 1 ... 2 …….……...

Witnesses names:

1 ... 2 …….………...

References

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