New Jersey Advance Directive For Health Care (Living Will) (Page 3 of 7) in pdf

New Jersey Advance Directive For Health Care (Living Will) Page 3

New Jersey Advance Directive for Health Care

(Living Will)

** I, ______________________________________________ (print your name), being of a

sound mind and a competent adult knowing my right regarding medical care and treatment, do

hereby execute this legally binding document expressing my wishes and directions to my family

and health care providers of the treatment and care that I desire in the event that I am prevented

by either physical or mental incapacity from making future medical decisions.

A - Terminal Condition

If I am diagnosed as having an incurable and irreversible illness, disease or condition and if my

attending physician an at least one additional physician who has personally examined me

determines that my condition is terminal:

1. ________

I direct that life-sustaining treatment which would serve only to

artificially prolong my dying be withheld or ended. I also direct

that I be given all medically appropriate treatment and care

necessary to make me comfortable and to relieve pain.

2. ________

I direct that life-sustaining treatment be continued, if medically

appropriate.

B – Permanently Unconscious

If there should come a time when I become permanently unconscious and it is determined by my

attending physician and at least one additional physician with appropriate expertise who has

personally examined me that I have totally and irreversibly lost consciousness and my ability to

interact with other people and my surroundings:

1. ________

I direct that life-sustaining treatment be withheld or discontinued. I

understand that I will not experience pain or discomfort in this

condition, and I direct that I be given all medically appropriate

treatment and care necessary to provide for my personal hygiene

and dignity.

2. ________

I direct that life-sustaining treatment be continued, if medically

appropriate.

C – Incurable and Irreversible Conditions that are not Terminal

New Jersey Advance Directive For Health Care (Living Will) Page 3