New Jersey Advance Directive For Health Care (Living Will) printable pdf download

GUIDELINES FOR COMPLETING THE NEW JERSEY ADVANCE DIRECTIVE FOR

HEALTH CARE (LIVING WILL)

Prior to executing a New Jersey Advance Directive for Health Care (commonly known as a

Living Will) and the Durable Power of Attorney For Health Care for the Appointment of a

Health Care Representative (Proxy Directive), you should consult with your physician,

hospital, family and become fully informed about your rights regarding medical treatment,

the procedures and options available and all matters related to these important legal

documents and their consequences.

After a full understanding, you may complete the document by printing your name on the top

line of the document in the space provided for that purpose.

Under the headings A – TERMINAL CONDITIONS, B – PERMANENTLY

UNCONSCIOUS and C – INCURABLE AND IRREVERSIBLE CONDITIONS THAT

ARE NOT TERMINAL you should denote your preferences regarding treatment by marking

a check or an (X) after number 1 if you wish to direct the withholding or discontinuation of

medical treatment. If you wish to direct the continuation of life-sustaining treatment you

must mark a check or an (X) on the space after the number 2.

Under the heading D- EXPERIMENTAL AND/OR FUTILE TREATMENT, you may mark

a check or make an (X) in the space marked 1 only if you want this form of therapy or

treatment withheld or withdrawn.

The heading E – BRAIN DEATH provides you with the option of excluding your death from

being declared on the basis of the irreversible cessation of the entire brain, including the

brain stem.

The heading F – SPECIFIC PROCEDURES AND/OR TREATMENTS provides you with

the opportunity to express your desire and wishes regarding some specific medical treatment

options. Should you want a particular treatment you should mark a check or make an (X)

following the words: “I do want.” Should you oppose a particular treatment or procedure,

mark a check or make an (X) following the words: “I do not want.”

The heading G – ORGAN DONATION provides you with the choice of donating your

organs or not. Should you wish to donate your whole body to science for research or give

any specific instructions regarding organ donations, you may write those directions in the

box labeled specific instructions.

Under the heading for SPECIFIC INSTRUCTIONS there is a boxed space that enables you

to write any wishes, directions and instructions that you wish to add to the document. This

space enables you to craft the document to address your personal philosophy, value system,

religious concerns and any other instructions.

The heading DURABLE POWER OF ATTORNEY FOR HEALTH CARE for the

APPOINTMENT of a HEALTH CARE REPRESENTATIVE (PROXY DIRECTIVE),

New Jersey Advance Directive For Health Care (Living Will)