New Jersey Living Will Template
This Living Will is made in accordance with the New Jersey Advance Directives for Health Care Act, N.J.S.A. 26:2H-53 et seq.
I, [Your Name], born on [Your Date of Birth], residing at [Your Address], hereby declare this Living Will regarding my health care preferences in the event that I become unable to communicate my wishes.
1. Medical Treatment Preferences:
- If I am diagnosed with a terminal condition or a condition that leaves me unable to make my own decisions, I do not want:
- Any life-sustaining treatment that serves only to prolong the dying process.
- Food and water delivered by medical means, if such support would only prolong the dying process.
- To be resuscitated in the event of cardiac or respiratory arrest.
2. Healthcare Proxy:
I appoint the following individual to be my healthcare representative:
Name: [Proxy Name]
Address: [Proxy Address]
Phone: [Proxy Phone Number]
3. General Provisions:
- This Living Will reflects my wishes and values in regard to medical treatment.
- I understand that I can revoke or change this Living Will at any time, as long as I am competent to do so.
- This Living Will shall remain in effect until revoked or modified by me.
4. Signatures:
Signed this [Day] of [Month], [Year]:
_____________________________
(Signature of Declarant)
Witnesses:
In accordance with New Jersey law, this Living Will must be witnessed by two adults who are not related to the declarant:
_____________________________
(Signature of Witness 1)
Name: [Witness Name 1]
Address: [Witness Address 1]
_____________________________
(Signature of Witness 2)
Name: [Witness Name 2]
Address: [Witness Address 2]
This document is intended to provide clarity regarding my healthcare preferences, should I be unable to communicate these wishes myself.