I, _____________________________________, do willfully and voluntarily make known my desire that my dying be artificially prolonged for as long as is possible, under the circumstances set forth below.

In the event of my mental incapacitation, I hereby authorize that:

[ ] A small minority of sexually repressed religious people take up my cause and launch a nationwide disinformation campaign to keep me alive in pursuit of a tenuous connection between my condition and abortion.

[ ] Said religious activists can pursue this goal by traditionally "sinful" means; e.g. dishonesty and/or corruption, without suffering any aggregate guilt or self-doubt.

[ ] Furthermore, said Pro-life activists are estopped from experiencing any inner turmoil regarding their apparently conflicting views on the death penalty and any number of shoddily justified military invasions.

Section 2: Media Frenzy (Non-Caucasians may skip this section)

If, in the event of my permanent incapacity, there is a dispute regarding my condition/wishes, I hereby authorize that:

[ ] A wildly disproportionate media circus descend upon the medical facility where I am located, at least large enough that there are two (2) to three (3) reporters for each protester.

[ ] At least three (3) unscrupulous doctors and three (3) money-grubbing nurses are hired to advance plainly false diagnoses in an effort to strengthen otherwise baseless claims about my condition/wishes/fondness for ragtime music and Jell-O.

Section 3: Legislation (Non-Caucasians may skip this section)

In the event of my incapacitation, I hereby authorize:

[ ] That the governmental bodies of my state and nation can take a pass on more pressing issues of global import in order to address a problem which affects only a handful of people in any meaningful way; i.e. my condition.

[ ] That a law named after me be passed in an attempt to erode individual rights, the separation of powers, and the church/state division by exploiting my condition.

If said law is overturned on constitutional grounds, I hereby authorize that the presiding judge be labeled as "pro-death" and subjected to:

[ ] Various forms of politically motivated slander and/or libel

[ ] Any number of death threats

[ ] Assassination

In the event that I am determined to be unable to provide express and informed consent regarding the withholding, withdrawal, or continuation of life-prolonging procedures, I wish to designate, as my surrogate to carry out the provisions of this declaration;

[ ] My mother

[ ] My father

[ ] Your mother (just kidding)

[ ] My spouse (unless he/she starts fooling around)

[ ] Tom Delay

[ ] Rev. Jesse Jackson

[ ] "Fox & Friends"

[ ] Judge Judy

[ ] Jesus H. Christ

[ ] Other: ____________________

I, _____________________________________, do willfully and voluntarily make known my desire that my death be hastened by any means possible in the event of an incapacitating injury, late-stage terminal disease, head cold, severe depression or mild embarrassment, under the conditions set below.

If any friend, spouse or family member should attempt to prevent the cessation of life support, they should be informed that such action disqualifies them from receiving any money or assets awarded them in my will (AKA "Dying Will"). That’ll shut ‘em up.

If possible, I prefer the means employed in my state-sponsored killing to be:

[ ] Protracted dehydration (not painful!)

[ ] Calculated morphine overdose

[ ] Smothered between Lindsay Lohan’s breasts

[ ] Totally extreme!

[ ] Death by Chocolate

I hereby authorize that my body be disposed of in the following way:

[ ] Hefty Cinch-sack

[ ] Stuffed and mounted across the street from Jerry Falwell’s house

[ ] Burn, baby burn

[ ] As a conveyance for explosives in a terrorist attack, because I hate American values

[ ] As a delicious entrée for the ACLU Board of Directors’ annual "Death Culture Luncheon"

In the event that there is any kind of afterlife, I would prefer to:

[ ] Go to Heaven and roll my eyes whenever anyone talks

[ ] Go to Hell; I’ve always wanted to meet the Pope

[ ] Go to Purgatory and catch up on "Crossing Jordan" re-runs

[ ] Go to Hades just to be different

[ ] Stay on Earth as a ghost and haunt my ex

[ ] Be reincarnated as a man/woman with a giant phallus/set of boobs

In the event that I am determined to be unable to provide express and informed consent regarding the withholding, withdrawal, or continuation of life-prolonging procedures, I wish to designate, as my surrogate to carry out the provisions of this declaration;

[ ] Jack Kevorkian

[ ] Jay Wolfson

[ ] Wolfman Jack

[ ] Klaus von Bulow

[ ] Noam Chomsky

[ ] Robert Blake

[ ] Christopher Hitchens

[ ] Anna Nicole Smith

[ ] My ungrateful, sponging kids

[ ] Any Jewish guy from New York

[ ] Other ____________________