This Living Will is designed to be used by residents of New Jersey, ensuring that it adheres to the New Jersey Advance Directives for Health Care Act. It is a legal document that outlines your preferences regarding medical treatment in the event that you cannot communicate your decisions yourself. By completing this document, you are taking a crucial step in managing your future health care needs.
Please provide the following information accurately to ensure this Living Will reflects your wishes:
Declaration: I, _____________ (the "Declarant"), residing at _________, in the city of _________, New Jersey, being of sound mind, do hereby make, declare, and publish this Living Will. It is my intention that this document shall be honored by my family, doctors, and any other health care providers as the final expression of my legal right to refuse medical or surgical treatment, even if it means I might die.
This Living Will shall become effective only when I cannot effectively communicate my intentions and am diagnosed by two physicians to be in either a permanent vegetative state, in a terminal condition, or in a condition where the application of life-sustaining treatment would only serve to artificially prolong the process of dying.
I direct that:
- All treatments that would only serve to extend my dying process or maintain me in a state of permanent unconsciousness be withheld or withdrawn, in accordance with my right to refuse treatment.
- Nutrition and hydration (food and water) be withheld or withdrawn if my condition is hopeless.
- I wish to receive maximum comfort care, including pain relief.
These decisions are based on my personal values and beliefs and are not dictated by doctors, family, or financial considerations.
If I have appointed a Health Care Proxy in addition to this Living Will, I direct my health care providers and family to honor the decisions made by my appointed agent, who is named in a separate document, to act on my behalf in accordance with this document.
Signature: ___________________________ Date: ____________
Witness Declaration
We, the undersigned witnesses, declare that the Declarant is personally known to us, that he/she signed this Living Will in our presence, and that he/she appears to be of sound mind and not under duress, fraud, or undue influence. We are not related to the Declarant by blood or marriage, and we would not be entitled to any portion of the Declarant's estate upon his/her death under any will or by operation of law.
Witness #1 Signature: ___________________________ Date: ____________
Witness #2 Signature: ___________________________ Date: ____________