4 Sign a Living Will /Advance Directive in the event you become permanently unconscious, are in a terminal condition or serious irreversible illness A Living Will is your written expression of how you want to be treated in certain medical conditions. This document will permit you to express whether or not you wish to be given life-sustaining treatments in the event you are terminally ill or injured, to decide in advance whether you wish to be provided food and water via intravenous devices ("tube feeding"), and to give other medical directions that impact the end of life. "Life-sustaining treatment" means the use of available medical machinery and techniques, such as heart-lung machines, ventilators, and other medical equipment and techniques that will sustain and possibly extend your life, but which will not by themselves cure your condition. In addition to terminal illness or injury situations, NJ will permit you to express your preferences as to treatment using life-sustaining equipment and/or tube feeding for medical conditions that leave you permanently unconscious and without detectable brain activity. Example: A. Fluids and Nutrition. I request that artificially provided fluids and nutrition, such as by feeding tube or intravenous infusion [Most people initial #1] 1. ______ shall be withheld or withdrawn as "Life Sustaining Treatment." 2. ______ shall be provided to the extent medically appropriate even if other "Life Sustaining Treatment" is withheld or withdrawn.
B. Directive as to Medical Treatment. I request that "Life Sustaining Treatment" be withheld or withdrawn from me in each of the following circumstances: ] (Most people initial 1-4 ) 1. ______ If the "life sustaining treatment" is experimental and not a proven therapy, or is likely to be ineffective or futile in prolonging my life, or is likely to merely prolong an imminent dying process; 2. ______ If I am permanently unconscious (total and irreversible loss of consciousness and capacity for interaction with the environment); 3. ______ If I am in a terminal condition (terminal stage of an irreversibly fatal illness, disease, or condition); or 4. ______ If I have a serious irreversible illness or condition, and the likely risks and burdens associated with the medical intervention to be withheld or withdrawn outweigh the likely benefits to me from such intervention. ___ None of the above. I direct that all medically appropriate measures be provided to sustain my life, regardless of my physical or mental condition. [This means you want to be kept alive with tubes, no one pick this] If you or anyone you know needs an updated Will, Power of Attorney or Living Will, please have them fill out our confidential interview form. Contact the Law Office of Kenneth Vercammen at 732-572-0500.
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