GERIA REPORTINGS
• Lung injury
DO NOT RESUSCITATE
ORDERS
WHAT IS DNR?
A DO- NOT- RESUSCITATE (DNR) order is a
legal document signed by the patient and the
provider. It tells emergency responders and other
healthcare providers to not perform
cardiopulmonary resuscitation (CPR) if your heart
stops (called cardiac arrest) or you stop
breathing.
IN A DNR ORDER, CPR REFERS TO:
• Pressing on the chest or using electricity or
medications to restart the heart.
• Mouth-to-mouth breathing (if outside of a
hospital).
• Placing a breathing tube down your throat
and connecting you to a machine called
a ventilator.
WHY ARE DNR ORDERS USED?
• DNR orders are used when there is a lower
chance of survival with CPR if a person’s
heart stops beating.
• We often see people survive after CPR on
television and in movies. However, we
tend to overestimate the success of CPR. It
can double or triple the chance of
survival, but only 10% to 20% of people
actually survive after cardiac arrest
outside the hospital. This number is even
lower in people with several chronic health
conditions and terminal illnesses, like
advanced cancer.
EVEN IF A PERSON IS BROUGHT BACK TO LIFE
AFTER CPR, THEY ARE NOT LIKELY TO RETURN
BACK TO THEIR NORMAL STATE OF HEALTH.
THE FOLLOWING ARE COMMON
AFTERWARDS:
• Brain damage
• Heart damage
• Internal bleeding
• Broken ribs
So, in many cases, the risk of pain and harm from
CPR is much higher than the benefits. Some
people simply don’t want to be on life support at
the end of their days, so they choose a DNR order
to prevent that.
WHEN MIGHT SOMEONE CONSIDER A
DNR ORDER?
Any adult can request a DNR order. The order is
commonly considered if a person would likely not
benefit from CPR. Some instances where a person
would consider a DNR order include:
• A short time left to live because of a
terminal illness.
• Serious chronic illnesses, such as
congestive heart failure or COPD.
• Decreasing quality of life or increasing
dependence on others for basic daily
needs
ARE DNR ORDERS ALLOWED ONLY FOR
PEOPLE WITH CERTAIN HEALTH
CONDITIONS?
A DNR order is allowed for any reason. Any adult
can request a DNR, including healthy adults.
People most likely to use them are those who
know in advance that their chance of surviving
CPR is very low and/or they don’t want to spend
their last days on life support.
ARE THERE CIRCUMSTANCES WHERE
MEDICAL PERSONNEL WILL
RESUSCITATE A PERSON EVEN WITH A
DNR ORDER?
Depending on state laws, medical personnel may
resuscitate a person with a DNR order if:
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• There is no written documentation of the
DNR order.
• They cannot find or confirm the DNR order.
• There is a question whether the DNR is
valid.
• The cause of the heart or breathing
stopping is from something unnatural, like
trauma or a sudden blockage in the
airway.

CAN A FAMILY REFUSE A DNR ORDER?

If a person has already completed a DNR order,
their family cannot refuse the order. If you have a
DNR order and your family members disagree,
medical personnel will still honor the patient’s
wishes. But the medical staff will communicate
with your family to try to get everyone on the
same page with your decision.

COMMUNICATING WITH PATIENT’S

ABOUT DNR

• Initiate an Understanding Discussion

• Be Clear About Your Prognosis
• Identify Your Patient’s Goals

THE BOTTOM LINE

A DNR order specifies when someone doesn’t
want CPR in an emergency. Other advance care
planning documents offer more detail about
medical treatments if you are very sick and can’t
communicate your wishes. Rules for DNR orders
and other advance care planning documents
vary by state, so it is important to check your local
laws. Be sure to let your family know your decisions
and the location of your documents so your
wishes are understood and honored.

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NURSES ROLE IN CARING

OLDER PEOPLE

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ORGAN DONATION
Organ Donation is the process of removing tissues
or organs from a live or recently dead person
called Donor to be used in another live person
called Recipient.

SITUATIONS UNDER WHICH ORGANS

DONATION OCCURS

Living Donation Deceased

Donation
When a living person Involves taking organs
wishes to donate from a person who has
organs to some just died.
immediate family
member in need.
Only first-degree Organ can be taken
relatives (parents, only if the deceased
siblings & children) are person registered
allowed to be Live his/her wish for the
Donors. donation or his first-
degree relatives give
their consent.
Can donate one Organs to be donated
kidney, a portion of depends on the type
pancreas and a part of death.
of the liver.

TYPES OF DEATH

Brain Death Cardiac Death

Irreversible and If person is on
permanent end of all ventilator and if
brain function. medically clear that
cannot survive, family
can consider Organ
donation for certain
vital organs

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LIVING DONOR REQUIREMENTS
• Good physical and mental health
• Must be at least 18 years old
• Must have a BMI that is <35
• Must be free form the following:
➢ Uncontrolled high blood
pressure
➢ Diabetes
➢ Cancer
➢ Hepatitis
➢ Organ’s diseases
➢ Infectious diseases

PROCESS OF ORGAN DONATION

The Philippines "Organ Donation Act of 1991"

updates the "1949 Act to legalize permissions to
use human organs". Under the new legislation,
each individual can donate all or any part of his
body by way of legacy or will.

“You must have been donating food, money,

shelter, etc. during your life time. Organ donation
gives you the chance to enhance that spirit by
recycling yourself even after death. “- Anonymous
–

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EUTHANASIA, SUICIDE AND TERMINATION OF LIFE ON REQUEST

AND ASSISTED SUICIDE ACT
ASSISTED SUICIDE
WHAT IS EUTHANASIA?
➢ Euthanasia or mercy killing is the practice
of intentionally ending a life in order to
relieve pain and suffering. It is when a
doctor is allowed by law to end a person’s
life by a painless means, as long as the
person and their family agree.
➢ In the other hand, majority of countries
euthanasia or assisted suicide is against
the law. According to the National Health ASSISTED SUICIDE
Service (NHS), it is illegal to help somebody
What is Assisted Suicide?
kill themselves, regardless of
circumstances. “Intentionally helping a person take their own life
by providing drugs for self-administration, at that
CLASSIFICATION OF EUTHANASIA person’s voluntary and competent request.”
• Voluntary
o When euthanasia is conducted OPTIONS FOR TERMINAL PATIENT OR
with consent. THOSE WITH INTRACTABLE SUFFERING
• Involuntary. AND PAIN
o When euthanasia is conducted on
• Patients with a terminal or serious and
a person who is unable to consent
progressive illness in most developed
due to their current health
countries have several options, including:
condition.
➢ Palliative Care
➢ Refusing Treatment
TWO PROCEDURAL CLASSIFICATIONS ➢ A living will (advance directive)
OF EUTHANASIA
• Passive euthanasia
PALLIATIVE CARE
• According to WHO it is an approach that
-is when life-sustaining treatments are
improves the quality of life of patients and
withheld. The definitions are not precise.
their families facing the problems
• Active euthanasia associated with life-threatening illness,
through the prevention and relief of
-is when someone uses lethal substances suffering by means of early identification
or forces to end the person’s life, whether by the and impeccable assessment and
individual themself or somebody else. treatment of pain and other problems,
physical, psychosocial and spiritual.

• One goal of palliative care is for the

patients and families to accept dying as a
normal process

• It seeks to provide relief from pain and

uncomfortable symptoms. Opioids are

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 GERIA REPORTINGS
commonly used to manage pain and
other symptoms.
REFUSING TREATMENT
A person can refuse treatment that is
recommended by a health professional,
as long as they have been properly
informed and are “of sound mind.”
A LIVING WILL (ADVANCE DIRECTIVE)
This is a legally binding document which
anybody may draw up in advance if they
are concerned that perhaps they will be
unable to expresses their wishes at a later
date. In the advance directive the
individual states what they want to
happen if they become too ill to be able
to refuse or consent to medical treatment.
ARGUMENTS FOR AND AGAINST
VOLUNTARY EUTHANASIA
Arguments for Voluntary Euthanasia
• Freedom of choice: Advocates argue that
the person should be able to make their
own choice.
• Quality of life: Only the individual really
knows how they feel, and how the
physical and emotional pain of illness and
prolonged death impacts their quality of
life.
• Dignity: Every individual should be able to
die with dignity.
• Witnesses: Many who witness the slow
death of others believe that assisted death
should be allowed.
• Resources: It makes more sense to
channel the resources of highly skilled
staff, equipment, hospital beds, and
medications toward lifesaving treatments
for those who wish to live, rather than
those who do not.
• Humane: It is more humane to allow a
person with intractable suffering to be
allowed to choose to end that suffering.
• Loved ones: It can help to shorten the grief
and suffering of loved ones.
• Prolongation of dying: if the dying process
is unpleasant, the patient should have the
right to reduce this unpleasantness.
ARGUMENTS AGAINST VOLUNTARY
EUTHANASIA
• The doctor’s role: Healthcare professionals
may be unwilling to compromise their
professional roles, especially in the light of
the Hippocratic Oath.
• Moral and religious arguments: Several
faiths see euthanasia as a form of murder
and morally unacceptable. Suicide, too, is
“illegal” in some religions. Morally, there is
an argument that euthanasia will weaken
society’s respect for the sanctity of life.
• Patient competence: Euthanasia is only
voluntary if the patient is mentally
competent, with a lucid understanding of
available options and consequences, and
the ability to express that understanding
and their wish to terminate their own life.
Determining or defining competence is
not straightforward.
• Guilt: Patients may feel they are a burden
on resources and are psychologically
pressured into consenting. They may feel
that the financial, emotional, and mental
burden on their family is too great.
• Mental illness: A person with depression is
more likely to ask for assisted suicide, and
this can complicate the decision.
• Slippery slope: There is a risk that
physician-assisted suicide will start with
those who are terminally ill and wish to die
because of intractable suffering, but then
begin to include other individuals.
• Possible recovery: Very occasionally, a
patient recovers, against all the odds. The
diagnosis might be wrong.
• Palliative care: good palliative care makes
euthanasia unnecessary.
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 GERIA REPORTINGS
• Regulation: Euthanasia cannot be properly Psychological Factors
regulated.
• Hopelessness
SUICIDE Environmental Factors
➢ It is a serious public health problem;
• Stressful life events
however, suicides are preventable with
timely, evidenced based and often low- • Prolonged stress
cost intervention
• Access to lethal means
➢ From Latin language ‘sui’ (oneself)
‘caedes’ (killing) • Exposure to another person’s suicide

➢ Suicide constitutes all cases of death • Isolation and lack of social support
directly or indirectly resulting from act of a
• Depressive (planned)
person who is aware of the consequences
of the behavior. • Impulsive

FACTORS AFFECT SUICIDE RATES • Away of attracting attention

SEX MODES OF SUICIDE

Men are “better” at suicide than women. Four • Drowning
times as men complete suicide, but women make
more attempts • Suffocation

AGE • Electrocution

Suicide rates increase with advancing age. More • Jumping from height
than half of all suicide victims are over 45 years
old. In fact, suicide is more common among 15-24 • Firearms
years old.
• Poison
MARITAL STATUS
• Drug overdose
Married individuals have lower rates than
divorced, widowed, or single persons. SUICIDE WARNING SIGNS
• Talk
HEALTH FACTORS
• Behavior
Mental Health Conditions
• Mood
• Depression

• Bipolar (manic-depressive) disorder TYPES OF THERAPY

• Schizophrenia • Family therapy

• Borderline or antisocial personality disorder • Cognitive behavior therapy (CBT)

• Anxiety disorders • Problem solving therapy

• Substance abuse disorders. • Group therapy

• Medications

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ADVANCE MEDICAL
DIRECTIVES
• These are documents that permit people
to set forth in writing their wishes and
preferences regarding health care.
These legal documents are used to
indicate the patient/resident’s health care
decisions if the time should come when
they are unable to speak for themselves.
• Some AMD’s also permit people to
designate someone to convey their wishes
in the event they are rendered unable to
do so. The AMD is helpful to professionals
because it provides information and
guidance based on the person’s wishes of
their treatment decisions.
• Many issues pose problems to the
professional in honoring advance
directives.
• FIRST, AN ADVANCE DIRECTIVE IS NOT
OPERATIVE UNTIL THE PATIE NT IS NO
LONGER CAPABLE OF DECISION
MAKING (MAYO CLINIC, 2017).
THEREFORE, THE FIRST DECISION MUST
BE WHETHER A PATIENT IS CAPABLE OF
MAKING A DECISION OR WHETHER
THE ADVANCE DIRECTIVE MUST BE
FOLLOWED. AT TIMES, THE PATIENT
MAY BE AWAKE AND RESPONSIVE BUT
NOT CLEAR IN HIS OR HER ABILITY TO
THINK OR COMMUNICATE. HOWEVER,
IF A DETERMINATION OF INCAPACITY
IS MADE, THEN AN ADVANCE
DIRECTIVE MAY BE LOOKED TO, AS IT
WOULD SPEAK WHEN THE PERSON
CANNOT.
• Sometimes, the policy of the provider or
the judgment of the treating physician
may not be in accord with the patient's
wishes. In such cases, it is necessary to
advise the patient of this.
• For example, if a nursing facility does not
offer CPR and the patient desires that
option, then the facility must advise the
patient and offer the option of transfer. In
the same way, a physician who does not
agree with or cannot carry out the
patient's wishes must advise the patient of
this and must then transfer the care of the
patient to another physician as soon as it is
practical to do so. The right to self-
determination is well grounded in the
common law and is interpreted in the U.S.
Constitution under the right of liberty.
• The statutory developments and
codification of these principles promote
communication and make it easier for
individuals to
• exercise their right to autonomy.
PHYSICIAN’S ORDERS FOR LIFE-
SUSTAINING TREATMENT
(POLST)
• Physician Orders for Life-Sustaining
Treatment, or more commonly known as
POLST, is a process of communicating
health care wishes during a medical crisis
or decline in health (National POLST
Paradigm, Fundamental Policy Principles,
2017). This tool is seeing more frequent use
and allows the patient to communicate
with their physician to set forth medical
orders to be followed.
• The POLST form is not meant to replace
traditional end-of-life care communication
tools such as advance directives or "no
code" or DR statuses. Rather, it augments
these tools to provide a comprehensive
set of patient preferences for care, more
so than simply a DNR. As a portable
medical order, the POLST form is an
ongoing order set that reflects the
patient's current preferences for care
(National POLST paradigm, 2017). As such,
this form needs to be reviewed with the
patient to assure their needs regarding
end- of-life care are met.
• Although POLST forms may have slight
variations from state to state, they are all
inclusive of the following three sections:
• (1) cardiopulmonary resuscitation (CPR),
• (2) medical interventions, and
• (3) artificially administered nutrition.
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NURSE’S BASIC ETHICAL
PRINCIPLES
ETHICS, VALUES AND MORAL
• Ethics is the study of good conduct,
character and motives. It is concerned
with determining what is good or
valuables for all people.
• A value is a personal belief about the
worth you hold for an idea, a custom, or
an object.
• Morals usually refer to judgment about
behavior and ethics is the study of ideals
of right and wrong behavior.
ETHICAL PRINCIPLES
• Autonomy: Independence; self-
determination; self-reliance
• Justice: Fairness or equity
• Fidelity: Faithfulness; striving to keep
promises
• Beneficence: Actively seeking benefits;
promotion of good
• Non maleficence: Actively seeking to do
no harm.
• Veracity: Being truthful, trustworthy, and
accurate in all interactions with others.
• Integrity: Acting consistently with honesty
and basing actions of moral standards.
CODE OF ETHICS
➢ The “Nightingale Pledge,” a modification
of the Hippocratic Oath (5th to 6th century
BC), was first developed in 1893 and
named in honour of Florence Nightingale.
➢ The code of ethics developed by the
American Nurses Association (ANA) is an
evolution of earlier attempts to delineate
ethical sstandards for nurses.
AMERICAN NURSES ASSOCIATION
(ANA)
1: Respect for human dignity: The nurse must show
respect for the individual and consider multiple
factors when planning and providing care. The
nurse ensures patients are fully informed and
prepared to make decisions about their
healthcare and to carry out advance health care
planning.
2: Commitment to patients: The nurse must always
remember that the primary responsibility is to the
patient and should help to resolve conflicts that
may occur between the patient and others and
avoid conflicts of interest or breach of professional
boundaries.
3: Protection of patients’ rights: The nurse must be
aware of legal and moral responsibilities related
to the patients’ rights to privacy and
confidentiality and participation in research.
4: Accountability: The nurse bears primary
responsibility for the care of the patient and must
practice in accordance to not only the Code of
Ethics but also the state nurse practice act and
any regulations or standards of care that apply to
nursing and healthcare.
5: Professional growth: The nurse must strive always
to promote health, safety and wellbeing of self
and others. The nurse must, in all circumstances,
maintain personal integrity and report violations of
moral standards.
6: Improvement of healthcare environment: The
nurse must recognize that some virtues are
expected of nurses, including those associated
with wisdom, honesty, and caring for others, and
that the nurse has ethical obligations toward
others. The nurse is also responsible for creating
and sustaining a moral working environment.
7: Advancement of the profession: The nurse must
contribute to the profession through practicing
within accepted standards, engaging in scholarly
activities, and carrying out or applying research
while ensuring the rights of the patients are
protected.
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 GERIA REPORTINGS
8: Health promotion efforts: The nurse recognizes
that health is a universal right for all individuals
and collaborates with others to ensure
improvement in the general health and to reduce
disparities. The nurse remains sensitive to cultural
diversity and takes action against human rights
violations, such as genocide, and other situations
that may endanger human rights and access to
care.
9: Participation in goals of the profession: The
nurse must promote and share the values of the
profession and take action to ensure that social
justice is central to the profession of nursing and
healthcare.
THE INTERNATIONAL COUNCIL OF
NURSES
The ICN Code of Ethics focuses on four different
elements: Nurses and:
1. People: Those in need of care are the primary
responsibility of the nurse, who must show respect
for diversity and cultural difference, uphold the
patients’ rights to privacy and confidentiality, and
promote social justice and professional values.
2. Practice: The nurse must practice responsibly
and recognize accountability for actions,
delegations, personal conduct, and provisions of
care.
3. Profession: The nurse must uphold the values of
the profession and promote the profession.
4. Co-workers: The nurse must demonstrate
respect for colleagues and collaborate with them
in the provision of care but must protect patients
from negligent or impaired healthcare providers.
LIVING WILLS
WHAT IS A LIVING WILL?
• A Living Will is a right given from one
person to another to discontinue life
support and permit the person to die
naturally; spells out medical treatments
you would and would not want to be used
to keep you alive, as well as your
preferences for other medical decisions,
such as pain management or organ
donation.
• A living will be a legal document that lets
a person state their wishes for end-of-life
medical care. Family members and
doctors use it to make decisions about
medical treatments when that person
can’t communicate or make decisions for
themselves.
• A living will can also be called an
advance directive or a healthcare
directive. Advance directives guide
choices for doctors and caregivers if
you're terminally ill, seriously injured, in a
coma, in the late stages of dementia or
near the end of life. Unexpected end-of-
life situations can happen at any age, so
it's important for all adults to prepare these
documents.
POWER OF ATTORNEY
How does a living will work with a Power of
Attorney?
• A medical or health care power of
attorney is a type of advance directive in
which POA allows older adult to choose
someone to legally make medical
decisions on their behalf. That person is
called the healthcare agent or proxy for
healthcare decisions.
• With these two documents, your senior
can control the types of treatment they’ll
receive at the end of their life and who will
make sure their wishes are carried out.
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 GERIA REPORTINGS
The person you choose to make decisions on
your behalf may be called one of the
following:
• Health care agent
• Health care proxy
• Health care surrogate
• Health care representative
• Health care attorney-in-fact
• Patient advocate
METHODS
Choosing a person to act as your health care
agent is important. Even if you have other legal
documents regarding your care, not all situations
can be anticipated and some situations will
require someone to make a judgment about your
likely care wishes.
You should choose a person who meets the
following criteria:
• Meets your state's requirements for a
health care agent
• Is not your doctor or a part of your
medical care team
• Is willing and able to discuss medical care
and end-of-life issues with you
• Can be trusted to make decisions that
adhere to your wishes and values
• Can be trusted to be your advocate if
there are disagreements about your care
WHAT’S INCLUDED IN A LIVING WILL?
Decisions in a living will usually include
preferences for:
• CPR / resuscitation to restart the heart if it
stops beating.
• Mechanical ventilation to take over
breathing if they’re unable.
• Tube feeding if they can’t eat or drink,
either by IV or tube in stomach.
• Dialysis if their kidneys no longer work.
• Antibiotics or antiviral medications to treat
infections.
• Comfort care (also called palliative care),
which basically means keeping them
comfortable and as pain-free as possible –
it could mean dying at home, getting pain
medications, being fed ice chips for a dry
throat, or avoiding invasive tests or
treatments.
• Organ and tissue donations for
transplantation.
• Donating their body for scientific study.
CARDIOPULMONARY RESUSCITATION
(CPR)
● Restarts the heart when it has stopped
beating. Determine if and when you
would want to be resuscitated by CPR or
by a device that delivers an electric shock
to stimulate the heart.
MECHANICAL VENTILATION
● Takes over you’re breathing if you're
unable to breathe on your own. Consider
if, when and for how long you would want
to be placed on a mechanical ventilator.
TUBE FEEDING
● Supplies the body with nutrients and fluids
intravenously or via a tube in the stomach.
Decide if, when and for how long you
would want to be fed in this manner.
DIALYSIS
● Removes waste from your blood and
manages fluid levels if your kidneys no
longer function. Determine if, when and
for how long you would want to receive
this treatment.
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 GERIA REPORTINGS
ANTIBIOTICS OR ANTIVIRAL
MEDICATIONS
● Can be used to treat many infections. If
you were near the end of life, would you
want infections to be treated aggressively
or would you rather let infections run their
course?
COMFORT CARE (PALLIATIVE CARE)
● Includes any number of interventions that
may be used to keep you comfortable
and manage pain while abiding by your
other treatment wishes. This may include
being allowed to die at home, getting
pain medications, being fed ice chips to
soothe mouth dryness, and avoiding
invasive tests or treatments.
ORGAN AND TISSUE DONOR
● For transplantation can be specified in
your living will. If your organs are removed
for donation, you will be kept on life-
sustaining treatment temporarily until the
procedure is complete. To help your
health care agent avoid any confusion,
you may want to state in your living will
that you understand the need for this
temporary intervention.
DONATING YOUR BODY
● For scientific study also can be specified.
Contact a local medical school, university
or donation program for information on
how to register for a planned donation for
research.
DO NOT RESUSCITATE AND DO NOT
INTUBATE ORDERS
• You don't need to have an advance
directive or living will to have do not
resuscitate (DNR) and do not intubate
(DNI) orders.
• To establish DNR or DNI orders, tell your
doctor about your preferences. He or she
will write the orders and put them in your
medical record.
HOW DOES A LIVING WILL HELP
SENIORS AND HEALTH CARE
PROVIDERS?
• A living will help you and your family make
decisions about your senior’s care. If you
don’t know their specific end-of-life wishes,
you’ll have to make a best guess – a very
stressful situation! Even worse, family
members might end up arguing over
treatments.
• Also, if an older adult wants their
unmarried partner or trusted friend to be in
charge of their medical decisions, they
must have a living will and medical POA in
place. Otherwise, doctors won’t even be
able to talk with them about medical
decisions.
DIFFERENT STATES HAVE DIFFERENT
LAWS FOR LIVING WILLS
The Will must be either:
1) executed, signed, and sworn to by the
Testator and three witnesses before a
Notary (A Notarial Will); or
2) entirely handwritten, dated, and signed
by the Testator (A Holographic Will).
WHEN IS A WILL NOT A LEGAL WILL?
• In the Philippines, a valid Will is always a
signed and Notarized document.
• Must always be in written form, other
modes of expressing how one wants his
Estate to be distributed are not considered
Wills under Philippine Law.
• A video recording of the patient in which
he narrates how he wants his treatment
would be and what he wants and doesn’t
consider.
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 GERIA REPORTINGS
TWO TYPES OF WILLS IN THE three
competent
PHILIPPINES Witnesses all in
each other’s
Notarial Will Holographic Will presence.
● A Notarial Will ● A Holographic
is a notarized Will is a
document. completely Studies have shown that older adults often feel
handwritten relieved after sharing their end-of-life wishes. It’s
● It must be
document. usually because they have specific preferences or
signed and
sworn to by the ● It need not be don’t want to burden their families with those
Testator himself Witnessed or decisions.
or signed for Notarized.
him by a Older adult’s wishes will be honored and often
● It must be
person in his puts their minds at ease.
entirely written,
presence at his dated, and
express signed by the
direction, and
hand of the
also signed Testator
and sworn to
himself.
by three or
more credible ● The Testator
Witnesses all in should sign at
each other’s the bottom of
presence. the
Holographic
● The three
Will.
Witnesses
should not be ● Any additional
beneficiaries of provisions
the Will or, if written below
they are, his signature
additional must be dated
Witnesses must and signed by
also duly him to make
witness the them valid.
signing of the ● Any insertion,
Will. cancellation,
● The Testator (or erasure, or
the person alteration in a
requested by Holographic
him to write his Will must be
name) and the authenticated
Witnesses shall by the Testator
also sign each with his full
and every signature.
page of the ● A Holographic
Notarial Will in Will only
the left margin. requires the
Testator to
write it by
hand rather
than have the
elaborate ritual
of having it
signed and
notarized with

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