I wish to leave the confines of my body and flee my restless state of silent chaos
Escaping the binding mental chains placed on me with the contractual accurateness
Of a bullet through the temple of my cranium or an arrow through my beating heart
For when fermented drink no longer quenches my heavy thirst but instead renders
And delivers me all but dead and in a diabetic state of permanent comatose
The time has come for me to go…
And when the Pharmacist no longer can prescribe for me what the Chemist will
Because I have become addicted to the numbness of my very own disease
I beg you God to provide grace and mercy for my soul
The time has come for me to go…

Ted Sheridan

http://www.poemhunter.com/poem/comatose-disclosure-form/