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Also known as Living Wills -- are instructions given by adults that specify what actions should be taken for their health in the event that they are no longer able to make decisions due to illness or incapacity.
The Kennedy Health System ensures that all adult patients are provided the opportunity to learn about and/or make a valid Advance Directive to indicate their decisions about life-prolonging treatment, and/or to appoint a proxy to speak for them should they lose their decision-making capacity or the ability to communicate choices.
It is recommended that patients create an Advance Directive when they are not in the midst of a healthcare crisis. Advance directives are helpful for any adult, young or old. they help relieve families of having to decide what care you would want if you are unable to make the decision and ensure that your wishes are fulfilled.
Frequently Asked Questions
What is an Advance Directive?
An Advance Directive is a way for an adult to tell professionals what kind of care he or she permits or rejects in case he or she loses the ability to make choices about healthcare. If you have one, the law requires that the directions in it be followed.
Can anyone prepare an Advance Directive?
Any adult with capacity (18 years of age and older) may execute (make) an Advance Directive.
What kinds of Advance Directives are there?
In New Jersey, an Advance Directive (one form is commonly called a "living will") may come in the form of an Instruction Directive, a Proxy Directive, or a combination of the two.
(1) An Instruction Directive describes the care you want and want to refuse if you are unable to make decisions for yourself. You can identify treatments and choose to accept or refuse each kind (an example of this is a breathing machine). Instead, you can express your main values about life: you might want life sustained no matter what, or you might say when you think your life would have no value to you that you would want all life-saving care stopped.
(2) A Proxy Directive is also known as a Durable Power of Attorney for Healthcare. This document names one (or more) persons to speak for you when you have lost the ability to think well or make decisions. This healthcare representative could be a relative or friend. It cannot be your physician. It should be someone willing to make decisions for you about accepting, refusing, or withdrawing treatment if you cannot do so yourself. A good choice is a person willing to uphold your wishes. Thus, you should tell this person your values about life and treatment.
(3) A Combined Directive is when you complete both an instructional and proxy directive as indicated above. You identify treatments you are willing to accept or refuse, you set goals, and you name someone to speak on your behalf. The healthcare representative is supposed to uphold the directions in your instructional directive.
Which one should I use?
You must decide which one is best for you. Usually, the combined directive (# 3 above) is best and easiest for the family and physician. However, if you have no one to name as representative, you could choose the Instruction Directive alone.
Is an Advance Directive legal?
Yes. New Jersey law authorizes an individual to make an Advance Directive of any of the three types. They must be signed and witnessed. They are recognized in all 50 states. Advance Directives written in other states should be honored in accordance with our state law.
Must I hire an attorney to prepare an Advance Directive or Proxy Directive?
No. You may do so, but it is not necessary. Guest Services Representatives are available to assist you in writing any type that you choose. They help ensure that it is completed and properly witnessed to ensure it is valid. They also may act as a notary if you do not want other witnesses.
When is an Advance Directive legal?
It is important for the Advance Directive to be prepared properly. A New Jersey statute sets out specific requirements for making one. It must be signed by you and dated, or made at your direction, in the presence of one of the following:
The person witnessing your signature is attesting that you are of sound mind and free of duress and undue influence. When all necessary signatures are completed, the form is then legally binding, if and when you are not capable of making a decision by yourself. Your request must be followed by anyone involved in your care.
Must I consult with my doctor before preparing an Advance Directive?
No, but it is recommended so that you know how your illness or injury is likely to affect you, and so your physician is aware of your preferences. You may want to know how specific medical treatments or devices will affect you. In addition, it is always helpful for you to communicate your care preferences to your doctors.
Must I consult with family members or others (for example, those who are my representative) ?
Instruction Directives may only enforce the removal of life-sustaining treatment when you are permanently unconscious, terminally ill, or if the treatment is experimental, is likely to be ineffective or will merely prolong the dying process. Life-sustaining treatment may also be withdrawn if the patient has a serious irreversible illness or the treatment is very burdensome. The document does not permit a doctor to take pro-active steps to terminate life, but rather permits withholding of treatment. For example, an Advance Directive allows an individual to stop a breathing machine and provide comfort only.
When should an Advance Directive be used?
An Advance Directive becomes operative when you lack ability to decide. Also, your physician and the hospital must have a copy of it and check the conditions you state must be met. It must also conform to the law. Another doctor must confirm the belief that you lack decision-making capacity when that is questionable.
Where should I keep my Advance Directive?
The Advance Directive does you no good if it is not available. Since it obviously comes into play when you have lost the ability to express yourself, it is important for individuals other than yourself to know where it is. Our hospital will ask you for a copy in pre-admission testing, admissions, and during your initial intake by your nurse and physician. If it is not with you at admission, either ask to create a new one with Guest Services assistance, or ask that your verbal wishes are documented until the actual directive is obtained for the record. Make sure you keep your original and give copies to your proxy, family members, doctor and close friends. It is also a good idea to carry a copy. If you are going to a hospital, bring it and give it to the people taking care of you there. You should provide a copy of the Advance Directive with each hospital visit.
Whom should I appoint as my healthcare representative or proxy?
You should choose someone who is aware of your desires and whose judgment you trust. You should discuss your Advance Directive with that person and make sure he/she has a copy. It is important to make sure the person you select is willing to take on the role and responsibility of honoring any wishes you have made in your Advance Directive.
Can I revoke my advance directive?
Only you may revoke your Advance Directive. It may be revoked at any time by notifying the healthcare representative, doctor, nurse, other healthcare professional, or other reliable witness. Such notification can be written, oral, or by any other act evidencing an intent to revoke the document. Also, you may make new versions and cancel old ones.
Am I required to create an Advance Directive?
No. The statute gives you the option. No one can force you to create an Advance Directive. In fact, to be valid you must be free of duress and undue influence.
If a person has financial power of attorney, do they also have medical power of attorney?
Not always. Naming someone as proxy for healthcare must be specifically stated in the power of attorney document or the proxy directive.
How do I contact a Guest Services Representative for help with creating an Advance Directive?
These representatives are located in each hospital and can be contacted via your room phone by dialing only the last four digits of the number: