I, _________________, being of sound mind and body, do not wish to be kept alive indefinitely by artificial means. Under no circumstances should my fate be put in the hands of pinhead partisan politicians who couldn't pass ninth-grade biology if their lives depended on it, or lawyers/doctors/hospitals interested in simply running up the bills.
If after a reasonable amount of time passes, and I fail to ask for -- (check all appropriate items):
____Martini
____Margarita
____Scotch and soda
____Bloody Mary or beer
____Gin and tonic
____Glass of Chardonnay
____Steak
____Lobster or crab legs
____the TV remote control
____bowl of ice cream
____the sports page
____Sex or
____Chocolate, it should be presumed that I won't ever get any better.
When such a determination is reached, I hereby instruct my appointed agent and attending physicians to pull the plug, reel in the tubes, and call it a day. At this point, it is time to call the New Orleans Jazz Funeral Band to come and do their thing at my funeral, and ask all of my friends to raise their glasses to toast the good times we have had.
Signature:__________________________ Date: _________________
PS: I heard that there is a nursing home with a pub in Ireland, where the patients are happier, they have a lot more visitors, and some of them don't even need embalming when their time comes. If anyone knows the name of this happy place, PLEASE let me know immediately, and please pass the information to everyone.
PPS: I want to add amendments to this form under the following conditions:
Amendment #1:
Should I become incapacitated as described above, DO NOT UNDER ANY CIRCUMSTANCES PULL THE PLUG until after I have voted against Barack Obama by absentee ballot in the November 2012 election.
Signature:__________________________ Date: __________________
Amendment #2:
If Barack Obama gets re- elected, PLEASE PULL THE PLUG IMMEDIATELY and SHOOT ME TWICE -- (one time each in the heart and in the head) to make sure I am really dead!
Signature:__________________________ Date: __________________
Author Unknown
If after a reasonable amount of time passes, and I fail to ask for -- (check all appropriate items):
____Martini
____Margarita
____Scotch and soda
____Bloody Mary or beer
____Gin and tonic
____Glass of Chardonnay
____Steak
____Lobster or crab legs
____the TV remote control
____bowl of ice cream
____the sports page
____Sex or
____Chocolate, it should be presumed that I won't ever get any better.
When such a determination is reached, I hereby instruct my appointed agent and attending physicians to pull the plug, reel in the tubes, and call it a day. At this point, it is time to call the New Orleans Jazz Funeral Band to come and do their thing at my funeral, and ask all of my friends to raise their glasses to toast the good times we have had.
Signature:__________________________ Date: _________________
PS: I heard that there is a nursing home with a pub in Ireland, where the patients are happier, they have a lot more visitors, and some of them don't even need embalming when their time comes. If anyone knows the name of this happy place, PLEASE let me know immediately, and please pass the information to everyone.
PPS: I want to add amendments to this form under the following conditions:
Amendment #1:
Should I become incapacitated as described above, DO NOT UNDER ANY CIRCUMSTANCES PULL THE PLUG until after I have voted against Barack Obama by absentee ballot in the November 2012 election.
Signature:__________________________ Date: __________________
Amendment #2:
If Barack Obama gets re- elected, PLEASE PULL THE PLUG IMMEDIATELY and SHOOT ME TWICE -- (one time each in the heart and in the head) to make sure I am really dead!
Signature:__________________________ Date: __________________
Author Unknown
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