Advance Care Planning
It is important for everyone to think about who you would want to speak on your behalf, and the type of care you would want, if you were to become seriously ill or unable to speak for yourself.
Though the topic may be difficult to discuss, your values and priorities are important. The conversations around these values and priorities are what we call advance care planning. Advance care planning is meant to be an ongoing discussion.
We recommend that you discuss Advance Care Planning with your health care team and others important to you while you are feeling well and able to consider your choices.
Advance Directives
What Are Advance Directives?
The best way to document your Advance Care Planning discussions is to complete an advance directive, which leaves a guide for those important to you and those who will make health care decisions on your behalf.
Advance directives honor your right to participate in your own health care. An advance directive is a legal document that you fill out to communicate your preferences about your health care, in case you cannot make health care decisions for yourself.
You are able to change your documented preferences in your advance directive as things change in your life.
You should review any documents you have signed at least once a year and when your health changes. Your most recently dated document replaces earlier versions.
There are two types of advance directives recognized by the state of New Jersey: a proxy directive and an instruction directive.
Proxy Directive
A Proxy Directive allows you to choose a Health Care Representative who you want to make your medical decisions if you are unable to make them yourself. A Proxy Directive is also called Health Care Proxy or a Durable Power of Attorney for Health Care.
A Health Care Representative’s responsibility is to make health care decisions on your behalf. This is different from the responsibilities of a person named in a general Power of Attorney whose role is to make financial and other non-medical decisions.
It is important that the person you designate as your Health Care Representative is an adult who knows you and your preferences and who you trust to make the decisions you would want on your behalf.
You may choose your spouse/domestic partner, adult child, parent, family member, friend, religious or spiritual advisor or any other adult as your Health Care Representative. The HMH Advance Directive form can guide you in your choices.
You may appoint a physician as your Health Care Representative, but they cannot serve as your physician and Health Care Representative at the same time. You cannot appoint any other employee or administrator of a health care institution in which you are a patient or resident as your Health Care Representative, unless they are related to you by blood, marriage, civil union, domestic partnership or adoption.
You may also appoint additional individuals to act as your Health Care Representative in the event that your primary Health Care Representative is unable, unwilling, or unavailable to act in that capacity.
Your chosen and documented Health Care Representative is always the person we turn to first. Think about who you would want to make your decisions and complete a proxy directive so your medical team can work with the person YOU choose.
Your Health Care Representative’s decision-making authority is not limited to end-of-life situations and includes any health care decisions on your behalf if you are unable to make decisions yourself.
When patients do not have a Proxy Directive, we turn to family and friends in the order shown here:
- Spouse or civil union partner, if not legally separated from the patient
- Domestic partner, recognized by the State of New Jersey, defined in statute
- Adult children (includes biologic and legally adopted children, but not step-children)
- Parents
- Adult siblings
- Other adult relatives (includes step-children)
- Close and caring friend
Instruction Directive
An Instruction Directive, also called a Living Will, is used to state your values and preferences about your health care in case you cannot make your own health care decisions.
A living will is not a medical order. Rather, it provides guidance to your health care team, those important to you and those who will make health care decisions on your behalf if you can no longer speak for yourself.
It also allows you to express what medical treatments you would and would not want in specific circumstances. A living will is most useful as a guide to decision making for patients who have no one to appoint as a Health Care Representative.
A number of living will templates are available for you to consider and personalize in order to document your goals, values, and preferences.
At Hackensack Meridian Health, we provide our patients with an easily accessible Advance Directive form. It contains both step-by-step instructions as well as Frequently Asked Questions, which will assist you in your completion of the form.
Completing An Advance Directive
Advance directives are voluntary - it is up to you if you choose to have an Advance Directive. You may choose to have a Proxy Directive, an Instruction Directive, both, or neither.
If you already have an Advance Directive and it reflects your current preferences, you do not need to complete new forms, even if it was completed in a state other than New Jersey.
If you have a completed Advance Directive document, please bring a signed version with you to your next health care appointment.
You may wish to speak with a member of your health care team about your choices. You do not need to consult an attorney to complete an Advance Directive. You may choose to do so if you wish.
In order for an Advance Directive to be valid, you must sign and date the document in front of two witnesses OR a notary. The witnesses cannot be anyone you named to be your Health Care Representative or an alternate.
You can find step-by-step instructions on how to complete your Advance Directive using this Advanced Directive Form. NOTE: Please print the form ONE SIDED to ensure legibility.
Consider What is Important to You
Think about your values and priorities and what is important to you when it comes to your health care. Decide who you want to make your decisions if you cannot make them yourself.
Consider who knows you best, who you trust, and who will honor your choices. Think about what you want your health care team to know about you.
Consider talking with people close to you. Although it can be difficult, the best time to start the conversation and to complete an Advance Directive is when you are able to carefully consider your choices.
Your health care team can share the kinds of health care decisions that are important for you to think about.
Some of the specific interventions that might be considered based on the preferences you express in a living will include:
- Use of CardioPulmonary Resuscitation (CPR) if you are found with no pulse and you are not breathing
- Use of a ventilator (breathing machine)
- Use of artificial nutrition (such as a feeding tube)
- Practitioner Orders for Life-Sustaining Treatment (POLST). Unlike an advance directive, POLST is intended for people who have serious illness with a limited life expectancy and is a medical order actionable in all settings.
How Advance Directives Are Used
It is important that you discuss the content of your advance directive with your health care team, those important to you and those who will make health care decisions on your behalf.
Please be sure to give copies of your advance directives to your Health Care Representative (and alternate Representative) and health care team.
Bring your advance directive to the hospital or other health care facilities for inclusion in the medical record. Federal and state law mandate that all care-providing facilities ask patients whether they have an advance directive and, if so, to ensure that a copy is in the medical record to guide decisions.
The provisions of an advance directive, including the powers of the Health Care Representative, are activated only when:
If you become unable to make your own health care decisions, your designated Health Care Representative will make health care decisions on your behalf. An Instruction Directive guides your health care team about your preferences for care if you are unable to make your own health care decisions.
If you have any questions or would like additional resources, please reach out to your health care practitioner or the Office of Patient Experience at your local hospital.
More About Hackensack Meridian Health
Learn more about our leadership, commitment to diversity, equity and inclusion, recent news and more.