|COMA AND REMOTE
STATE DIRECTIVE (a PDF form to print and fill out - link to the
PDF is under the instructions below)
A LIVING WILL FOR THOSE CONCERNED WITH COMMUNICATION
AND DECISION MAKING DURING STATES OF CONFUSION, DELIRIUM, STUPOR,
COMA, CATATONIA, ADVANCED DEMENTIA, AND OTHER
SO CALLED REMOTE STATES OF CONSCIOUSNESS
The Coma and Remote State Directive (CRSD) is an advance directive,
also known as a living will. The intention of this form is to
implement your wishes if you are ever in remote states of
consciousness. The CRSD helps ensure that you receive verbal and
nonverbal support for your awareness of spiritual, physical,
emotional, and cognitive experiences; and that you are facilitated in
making your own decisions while you are in remote states of
consciousness. We advise you to inform your durable power of attorney
for healthcare, family, friends, guardians, spiritual advisors,
therapists, lawyers, physicians, healthcare facilities, and others
about your wishes set forth in your CRSD.
Process oriented coma workers believe that people in coma and other
remote states of consciousness have awareness and are capable of:
experiencing meaningful inner awakenings that forward growth and
wholeness; communicating their wishes; and participating in life and
death decision making. Coma workers observe, follow, support, and
facilitate people's inner and outer processes by: perceiving and
encouraging subtle communication cues; setting up binary (yes/no)
communication systems; and closely attending to feedback from people
in remote states of consciousness.
Process oriented coma workers value the emotional, intellectual,
creative, social, cultural, and spiritual diversity of all people.
Other important decisions regarding your health care
1) Durable Power of Attorney for Health Care (Healthcare
Representative, Health Care Surrogate) and Alternate.
2) Do Not Resuscitate Order (If you so desire.)
3) Medical Directive that delineates very specifically which medical
interventions you want and do not want. (The Harvard Medical Directive
is one such form.)
Completing your CRSD form
Download, print out, and complete the
PDF form available by clicking
(Click on HERE.
If the link does not work, type this address into your browser address
If you don't have one, you can download a (free) PDF reader from:
You may cross out or add whatever you want to your form. Use extra
pages if necessary. Then initial any deletions or additions, including
extra pages, and sign and date your CRSD in front of two witnesses.
Have the witnesses initial any deletions, additions, and extra pages
and sign and date. In some jurisdictions a notary public’s signature
may be required. Also have your Durable Power of Attorney for
Healthcare (Healthcare Representative) and alternate read, sign, and
date the form to ensure they are informed of and in agreement with
Give copies to and discuss your completed form with some or all of the
I) Your Durable Power of Attorney for Healthcare and Alternate.
2) Your doctor(s)
3) Your designated coma workers
4) Relatives, guardians, and friends
5) Your assisted living facility, care home, hospice, or psychiatric
6) Acute care facilities when you register for admittance
7) Your lawyer
Ensure that your doctor and your care facilities place copies in their
medical files. Ask them to flag copies so that unfamiliar care givers
can become quickly aware of your wishes. Revise your CRSD as your
Coma worker contacts, publications, and other information are
available at: www.processwork.org,
Appreciation to Drs. Arnold and Amy Mindell for developing coma work,
and inspiration and advice on updating this CRSD form.
Ann Jacob, Tom Richards, David Bedrick, John Jardine, and Larry
thank you for technical, editorial, and legal advice.
Small donations ($5-$10) for this form are greatly appreciated.
Additional donations would support ongoing research and development of
coma work; the education of coma workers, families, and care givers;
and coma work with those in financial need.
Coma Communication & Process
Stan Tomandl, MA, PWD & Ann Jacob, BA Ed
COMA COMMUNICATION THERAPY ~ PROCESS ORIENTED FACILITATION
#502--620 View Street, Victoria, BC, Canada V8W 1J6
Phone+1.250.383.5677 Emailemail@example.com* URL*www.comacommunication.com*
Copyright 1992 and 2005 by Stan Tomandl