Perhaps something like this might work for others too.  

Feel free to copy and share.

This document is to direct

my medical care

in the event I

am unable to speak

 for myself.

I, Jean Ann Eisenhower, being of sound mind, hereby assert that God and I myself are my primary healers, along with food, herbs, prayer, and angelic help.

The American medical establishment has wounded me horrendously and repeatedly throughout my life, as a subject of childhood and probably ongoing mind control experimentation, so that my objection to their care is not simply philosophical, but is based on personal experience.  Therefore, I state with force my wish to have all persons who might have anything to do with my healthcare decisions to act so that I will not be further made vulnerable to suffer at their hands.

In the event I am ever unable to speak for myself and need medical care, I ask all involved to consult as many of my friends as are possible to select some number of herbalists and shamans as they think appropriate to oversee my care.

If an “establishment” medical professional is deemed necessary, his or her care must be in my home or the home of a friend or even outdoors, but never inside any hospital or AMA- or ADA-affiliated clinic, unless I am awake and of sound mind and able to state this clearly.  If it is deemed that I will die if I don’t enter a hospital or AMA- or ADA-affiliated clinic, then I choose to die.

I request painkilling medicines, which may be provided at my home or otherwise outside a hospital or clinic.

These wishes are not to be circumvented by anyone without it being understood by all that:

1) my hospitalization should be considered a kidnapping with probable other crimes associated,

2) I should be rescued, and

3) those responsible should be arrested and investigated for torture.

Sworn by all things holy,

Jean Ann Eisenhower

April 27, 2014