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 Full Name], residing at [Your Address], being of sound mind, do hereby declare this Living Will to express my wishes regarding medical treatment in the event that I become unable to communicate my preferences.
In the event that I am diagnosed with a terminal condition or am in a persistent vegetative state, I wish to make the following choices regarding my medical treatment:
- I do not wish to receive any life-sustaining treatment if it serves only to prolong the dying process.
- I wish to receive comfort care to alleviate pain and suffering, even if it may hasten my death.
- If I am unable to eat or drink, I do not want artificial nutrition or hydration.
Additionally, I appoint the following individual as my healthcare representative to make decisions on my behalf:
Healthcare Representative Name: [Representative's Full Name]
Relationship to Me: [Relationship]
Address: [Representative's Address]
Phone Number: [Representative's Phone Number]
This Living Will reflects my wishes and is valid until revoked. I understand that I may change or revoke this document at any time while I am still competent.
Signed this [Day] day of [Month], [Year].
Signature: ____________________________
Print Name: [Your Full Name]
Witnesses:
We, the undersigned witnesses, declare that the person who signed this Living Will is known to us, and that they signed it in our presence.
Witness 1: ____________________________
Print Name: [Witness 1 Name]
Address: [Witness 1 Address]
Witness 2: ____________________________
Print Name: [Witness 2 Name]
Address: [Witness 2 Address]