The Near Future - maybe
New Reform Medical Center
Serving your Community since 2010
Agreement and Release
As you enter this Hospital you understand, acknowledge and agree that this hospital rations medical care and services. This means that the hospital and physicians can determine that you may not be entitled to certain medical treatment, even if it is of benefit to you. Your physicians and hospital may conclude that medical costs to the community outweigh the benefits of the otherwise beneficial medical treatment for you, if one or more of the following criteria exist:
Age, (younger than 5 or older than 68);
Mental Abilities, (e.g., Dementia, Parkinson's disease, Schizophrenia);
Economic status, e.g., having exhausted all savings and home equity;
Your ability to contribute to the community in the future;
Non-existence of family and friends to object to our withholding medical treatments;
Other factors unique to you, personally.
Your understanding and acceptance of this agreement will benefit others of your fellow citizens through savings of scarce medical resources. Thank you for making medical care assessable for others.
I, (Patient’s Name) hereby release this hospital and any and all physicians who may participate in my medical care from any and all claims of negligence or wrongdoing of any kind.
Ezekiel Emanuel, M.D.
National Chief of Medical Reform
Dated: _______________________________
Patient/Power of Attorney/Surrogate
Approved by the US Government and Consensus Entities
