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Checklist: Questions to Ask Yourself

I. Thinking about Your Health Care Wishes?

A. Why am I writing an advance directive?
B. What are my treatment wishes?
1. in situations near the end of life?
2. in situations of serious injury or illness?

II. Talking with Others

A. Physicians and other health care professionals
1. do I understand the medical terminology?
2. do they understand my wishes?
B. My friends, family and others
1. have I directly and thoroughly discussed my wishes with them?
2. do they understand my wishes?

III. Selecting a Health Care Representative

A. Am I confident that my designated representative understands my personal values and health care wishes?
B. Does my health care representative understand his or her responsibilities?
C. Has he or she clearly agreed to serve as my representative and to communicate my wishes to my doctor and others concerned with my care?
D. Have I selected an alternative health care representative?

IV. My Instructions. Have I clearly stated my instructions and included other relevant information about my treatment wishes regarding:

A. the provision, withholding or withdrawal of specific treatments?
B. artificially provided fluids and nutrition?
C. the medical conditions in which I want my wishes implemented?
D. special considerations I may have concerning my care and treatment?

V. Witnesses. Have I had my directive properly witnessed?

VI. Distribution of My Advance Directive. Have I given a copy of my directive to those who should have one, such as:

A. my health care representative?
B. my physician or other health care provider?
C. the hospital or nursing home which I am about to enter?
D. family members, friends, alternate representatives and my religious advisor?

VII. Periodic Review. Have I made a note to review my directive on a regular basis in the future?

VIII. Wallet Card. Have I completed the wallet size card available to download here, which tells others I have an advance directive and who to contact for further information?

The information on Advanced Directives comes from a brochure titled "Advance Directives for Health Care - Planning Ahead for Important Health Care Decisions", a publication of the State of New Jersey Commission of Legal and Ethical Problems in the Delivery of Health Care (The New Jersey Bioethics Commission). To download a PDF of the complete brochure please click here.

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