New Jersey Living Will Template
This Living Will is designed to provide instructions regarding your medical treatment preferences in the event that you become unable to communicate these wishes. It is governed by the laws of the State of New Jersey.
Instructions: Please fill in the blanks with your personal information. Ensure that you sign and date the document after completing it. Consider discussing your decisions with your healthcare provider and loved ones.
Personal Information:
- Name: ________________________
- Address: ________________________
- City, State, Zip: ________________________
- Date of Birth: ________________________
Living Will Declaration: I, the undersigned, being of sound mind, make this declaration while I am still capable of understanding my medical care choices. If I become unable to make my own medical decisions and my condition is terminal or I am in a persistent vegetative state, I wish to make my preferences known regarding life-sustaining treatment.
Living Will Preferences:
- I do not wish to receive any life-sustaining treatments that would only prolong my dying process.
- If I am unable to breathe without assistance, I choose to have:
- □ Mechanical ventilation
- □ No mechanical ventilation
- If my heart stops, I choose to have:
- □ CPR (Cardiopulmonary resuscitation)
- □ Do not resuscitate (DNR)
- If I am unable to eat or drink, I choose to have:
- □ Artificial nutrition and hydration
- □ No artificial nutrition and hydration
Additional Instructions:
Any additional preferences or instructions can be provided here: ______________________________________.
Signature: ________________________
Date: ________________________
It is recommended to share copies of your Living Will with family members, your doctor, and any healthcare facility where you may receive treatment.