Because medical progress now makes it possible to prolong life beyond the point that may be desired by an individual, this right to decide has become increasingly important.

Decisions about life-prolonging treatments are often difficult and require very careful consideration. Ideally, these decisions should be made before a time of crisis, since full treatment will always be carried out unless the healthcare team has been instructed otherwise.

Such decisions can be communicated to the healthcare team by means of an advance directive for healthcare.

Because of the increasing public interest in advance directives, and in order to promote awareness of individual rights, the U.S. Congress passed the Patient Self-Determination Act, effective December 1991. Both state and federal laws require healthcare facilities to ask all patients, at the time of admission, whether or not they have executed an advance directive, and to provide information about advance directives and healthcare decision rights. Here are some common questions and answers about advance directives for healthcare:

What is an Advance Directive for Healthcare?

Click here for a copy of the Advance Directive form. This form can be filled in online, printed and signed.

It is a written document with directions regarding your healthcare, in case you are no longer able to make your wishes known. An advance directive may be a living will, a durable (medical) power of attorney for healthcare or a combination of both. It is an effective means of maintaining control over your medical care if you become unable to make these decisions.

What is a Living Will?

This document states your wishes or instructions for healthcare in advance. It usually includes specific directions regarding life-saving, life-sustaining, or life-prolonging treatments and the conditions under which you would or would not want such treatments to be carried out.

What is a Durable (Medical) Power of Attorney for Healthcare?

Also referred to as a healthcare proxy, this document appoints, in advance, someone to make healthcare decisions for you in your best interest, to the best of his/her ability, according to your wishes. This individual should be someone who knows your views regarding healthcare and will be able to speak on your behalf should the need arise. This individual is most often a spouse, a son or daughter or a close friend. Your physician cannot act as proxy. It is advisable to appoint a second proxy in case the first proxy is unavailable. A durable (medical) power of attorney (proxy) for healthcare offers another means of assuring that your wishes will be carried out.

What Are "Life-saving", "Life-sustaining" or "Life-prolonging" Treatments?

Some of these treatments include: if your heart stops, do you want to be resuscitated; if you are unable to breathe, do you want a machine to breathe for you; if you are unable to eat, do you wish to be fed artificially; and if your kidneys stop, do you wish to be put on a dialysis machine? You can specify in your living will which treatments you wish to be per-formed or withheld and under what conditions.

What Are "Comfort Measures?"

Measures such as pain medication, nursing care, and treatments for the purpose of providing comfort and relieving pain are known as comfort measures and will always be provided regardless of any advance directive.

How Should an Advance Directive for Healthcare be Written and Witnessed?

You can use a standard form, with any changes or additions you wish, or you can write your own advance directive. You should sign and date the document in the presence of two adult witnesses, who should also sign and date it, or you may have your signature notarized. An attorney is not necessary but may be consulted if desired.

Is an Advance Directive Legally Binding in New Jersey?

The U.S. Supreme Court in 1990 confirmed that a person's right to make choices about medical care is protected under the Bill of Rights. New Jersey law, effective January 1992, declares that written advance directives for individuals age 18 or over are legal and binding. Hospitals and physicians must honor your advance directive or, in case of disagreement, transfer you to another hospital or physician who will carry out your wishes.

What Should I do With My Advance Directive?

You should discuss it with your close family, and/or friends) and with your physician. It is important that your physician understands and agrees to carry out your wishes, should the need arise. Make sure a copy is given to your physician. You should keep the original in a place known to your family, and you should give a copy to the persons) who may someday need to produce it on your behalf. You might also give a copy to your clergyman and carry a card in your wallet identifying the location of your advance directive and the name of your healthcare proxy. A safe deposit box, where it would not be readily available when needed, should not be the only place to keep your advance directive. Most important, you should bring a copy of your advance directive with you (or have it brought by someone else) if you are hospitalized.

How Often Does an Advance Directive Need to be Updated?

Currently, there is no update requirement in the state of New Jersey. It is a good idea, how-ever, to review it every year, initial and date it, to show that it continues to express your wishes accurately. You may make additions, changes or deletions at any time, provided they are clearly initialed and dated. You can revoke your advance directive at any time if you change your mind.

Does a Living Will Affect Life Insurance?

No. New Jersey law clearly states that new insurance applications cannot be turned down or existing policies affected by an advance directive. Withholding or terminating life-saving, life-sustaining, or life-prolonging treatment is not considered suicide.

Where Can I Obtain an Advance Directive Form?

There are many different forms that may be available in many places, such as stationery stores, physicians' offices, houses of worship, the hospital and libraries.

What is Newton Medical Center's Policy Regarding Advance Directives for Healthcare?

It is the policy of Newton Medical Center to honor advance directives (except for directives which are prohibited by law). The Newton Medical Center Bioethics Committee offers consultation services, without charge, to assist in resolving any problems that may arise.

Where Can I Obtain More Information?

You can call Newton Medical Center's Social Services Department (973) 579-8620, Chaplain (973) 579-8625 or Community Benefits/ Education Program (973.579.8340). In addition, Newton Medical Center's Community Benefits /Education Program offers periodic education related to advance directives and other bioethical issues for the community. For the next program, or to arrange a program, call (973) 579-8340.

Newton Medical Center encourages every adult to consider completing an advance directive for healthcare while you are in good mental and physical health and able to consider the options carefully and thoroughly.

To find out more, call...

Social Services: (973) 579-8620
Chaplain: (973) 579-8625
Community Benefits/Education Program: (973) 579-8340