New Jersey Instruction Directive Form _ Living WillNew Jersey Instruction Directive Form _ Living WillNew Jersey Instruction Directive Form _ Living Will
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The New Jersey Commission on Legal and Ethical Problems in the Delivery of Health Care

INSTRUCTION DIRECTIVE
I understand that as a competent adult I have the right to make decisions about my health care. There may
come a time when I am unable, due to physical or mental incapacity, to make my own health care decisions. In
these circumstances, those caring for me will need direction concerning my care and they will require information
about my values and health care wishes. In order to provide the guidance and authority needed to make decisions
on my behalf:

A) I, _________________________________, hereby declare and make known to my family, physician, and
others, my instructions and wishes for my future health care. I direct that all health care decisions, including
decisions to accept or refuse any treatment, service or procedure used to diagnose, treat or care for my physical or
mental condition and decisions to provide, withhold or withdraw life-sustaining measures, be made in acc