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AWCA Resource Center

Retirement Planning

Instruction Directive (Living Will)

This content is provided for informational purposes only. For specific legal advice, please consult with a qualified professional or an official government agency.

An Instruction Directive, commonly referred to as a Living Will, is a component of an Advance Directive. It is a legal document in which you explicitly state the medical treatments you wish to receive or refuse under specific circumstances. This document becomes effective only after an attending physician formally determines that you have lost the capacity to make your own healthcare decisions. It serves as a crucial guide for family members and medical providers to honor your values and make informed decisions on your behalf.

Key Characteristics

  • Life-Sustaining Treatment: Specific instructions regarding the refusal or acceptance of interventions intended to prolong life, such as Cardiopulmonary Resuscitation (CPR) or mechanical ventilation.
  • Artificial Nutrition and Hydration: Decisions on whether to continue artificial nutrition (feeding tubes) or intravenous (IV) hydration when you are no longer able to take food or water by mouth.
  • Renal Dialysis: Instructions on whether to undergo blood filtration via a dialysis machine in the event of kidney failure.
  • Palliative and Hospice Care: Choices regarding comfort-oriented care focused on pain management and a dignified end-of-life experience rather than life-prolonging interventions.

The Role of a Living Will

  • Secures Self-Determination: Legally protects your right to make medical choices aligned with your personal values and religious beliefs.
  • Alleviates Family Burden: Prevents potential guilt or conflict among family members who might otherwise struggle with treatment decisions during a crisis.
  • Provides Clear Clinical Guidance: Communicates your wishes directly to medical staff, preventing unnecessary or unwanted aggressive interventions.

Drafting and Execution Procedures

Applications or inquiries can be made by individuals, legal representatives, government agencies, or hospitals. (You may draft this document yourself without the involvement of an attorney or physician.)

  1. Consultation: Carefully consider your preferred scope of treatment and discuss these values with your family and primary care physician.
  2. Document Preparation: New Jersey does not mandate a specific format; the NJ Department of Health standard form, Five Wishes, or a self-drafted document are all valid. (Often drafted alongside a Proxy Directive/Healthcare POA.)
  3. Legal Requirements: Must be signed by two adult witnesses (excluding the designated Health Care Agent) OR signed before a Notary Public or attorney.
    • *Notarization is not mandatory if two witnesses are present.
  4. Storage and Sharing: Provide copies to your primary physician, family, and your designated Health Care Agent.
    • Keep the original in an accessible location. Do not store it in a locked safe or a Safe Deposit Box where it cannot be reached in an emergency.

POLST

POLST (Practitioner Orders for Life-Sustaining Treatment) is an actual Medical Order used in conjunction with an Advance Directive along with Living Will. While an Advance Directive outlines your “wishes,” a POLST is an official order signed by a physician (or APN/PA) based on those wishes. It is a binding document that first responders, ER staff, and nursing home personnel must follow immediately in an emergency.


*A POLST does not replace an Advanced Directive and Living Will. The Advance Directive sets the general direction, while the POLST provides specific, actionable instructions for emergency scenes.

When is a POLST Necessary?

A POLST is not for everyone. Consultation with a physician is recommended for individuals who:

  • Have a serious, chronic, or progressive illness, or a life expectancy of less than 5 years.
  • Are planning to enter a nursing home or long-term care facility.
  • Are receiving in-home hospice services.
  • Have an increased risk of emergency due to advanced age.

Medical Treatment Level Codes

  • Full Code
    • Perform all possible resuscitative measures (CPR, ventilator, defibrillation) in the event of cardiac or respiratory arrest.
    • This is the hospital default unless otherwise specified.
    •  
  • DNR (Do Not Resuscitate)
    • Instructs medical staff not to perform CPR if your heart or breathing stops.
    • Other treatments (oxygen, medication, pain relief) will continue.
    •  
  • DNI (Do Not Intubate)
    • Refuses the insertion of a breathing tube (intubation) for mechanical ventilation. 
    • This is distinct from DNR; if only DNI is specified, CPR may still be performed.
    •  
  • DNH (Do Not Hospitalize)
    • Directs that you receive Comfort Care at your current residence (home, nursing home) rather than being transferred to a hospital during an emergency.
    • Typically applied to hospice or long-term care patients.


Keep your completed POLST (green paper) in a prominent location (refrigerator door, bedside, etc.) and share copies with your doctor and agent.

Contact

AgencyServices ProvidedContact Information
NJ ADRC

(Aging & Disability
Resource Connection)		Service connection and counseling for seniors, individuals with disabilities (18 and above), and family caregivers by county.1-877-222-3737
(Connects automatically to your local county office)
Bergen County Division
of Senior Services		Information, assistance, and referrals for legal services.One Bergen County Plaza, 2nd Floor,
Hackensack, NJ 07601
201-336-7400
seniors@bergencountynj.gov
NNJLS
(Northeast New Jersey Legal Services)		Free legal aid for low-income residents,
seniors, and the disabled (subject to eligibility).		190 Moore Street, Suite 100,
Hackensack, NJ 07601
201-487-2166
NNJLS.ORG
LSNJ
(Legal Services of New Jersey Hotline)		Statewide legal hotline providing free legal advice and information.1-888-576-5529
lsnjlawhotline.org

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