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ADVANCE DIRECTIVE
of ____________________

I, ____________________ (the "Donor"), of ______________________________________________________________, New Zealand, being of sound mind and at least 18 years of age, make this Advance Directive, fully understanding the consequences of my action in doing so. I intend this Advance Directive to be read by my health care providers, family, whanau and friends as a true reflection of my wishes and instructions should I lack Capacity and be unable to communicate such wishes and instructions.

Definitions
As used in this document:
1. "Advanced Illness or Injury" means a severe illness or injury from which there exists no reasonable medical probability of regaining decision-making capacity or surviving without continued life support.
2. "Capacity" means the ability to understand the nature of a decision about personal care and welfare, to appreciate the consequences of making or failing to make that decision, and to communication the decision.
3. "Code" means the Code of Health and Disability Services Consumers' Rights.
4. "Comfort care" means treatment, including prescription medication, provided to the patient for the sole purpose of alleviating pain and discomfort.
5. "Health care provider" means any person licensed, certified or otherwise authorised by law to administer health care in the ordinary course of business or practice of a profession.
6. "Life support" means any medical procedure, treatment or intervention which sustains, restores or supplants a spontaneous vital function. In this document the term does not include tube feeding or the provision of medication or the performance of a medical procedure when such medication or procedure is deemed necessary to provide comfort care or to alleviate pain.
7. "Persistently unconscious" means being in a profound state of unconsciousness caused by disease, injury, poison or other means from which there exists no reasonable expectation of regaining consciousness.
8. "Persistent vegetative state" means a permanent and irreversible condition in which there is:
  1. The absence of voluntary action or cognitive behaviour; and
  2. An inability to communicate or interact purposefully with the environment.
9. "Terminal condition" means a condition caused by injury, disease or illness from which there is no reasonable medical probability of recovery and which, without treatment, can be expected to cause death.
10. "Tube feeding" means the provision of nutrients or fluids by a tube inserted in a vein, under the skin in the subcutaneous tissues, or in the stomach (gastrointestinal tract).
Revoke Previous Advance Directive
I revoke any previous Advance Directive made by me.
In Force
This Advance Directive will be in effect only if and as long as I have been found to lack Capacity.
I give no one (including any Attorney appointed under a Power of Attorney for Personal Care and Welfare) any authority to disregard or override my instructions provided in this Advance Directive. Family members, relatives, friends may disagree with me, but any such disagreement does not diminish the strength or substance of my instructions.
Determination of Capacity
A determination of lack of Capacity will be made by my physician.
Notification on Determination of Incapacity
If a determination is made that I lack Capacity under the Code to make personal decisions on my own behalf then I instruct the person or persons making that determination to provide a written copy of that declaration to me.
Treatment Directions and End-Of-Life Decisions
I direct that my health care providers and others involved in my care provide, withhold or withdraw treatment in accordance with my directions below:
1. If I have an incurable and irreversible terminal condition that will result in my death within a relatively short time, I direct that:
  1. I be kept on any artificial life support as long as possible within the limits of generally accepted health care standards;
  2. I receive tube feeding if necessary, even if such feeding would have the effect of prolonging my life;
  3. Cardiopulmonary resuscitation be performed if, in the opinion of my doctor, it is necessary; and
  4. Should I develop another separate condition that threatens my life, such other illness be given active treatment if, in the opinion of my doctor, such treatment is indicated.
2. If I am diagnosed as persistently unconscious and, to a reasonable degree of medical certainty, I will not regain consciousness, I direct that:
  1. I be kept on any artificial life support as long as possible within the limits of generally accepted health care standards;
  2. I receive tube feeding if necessary, even if such feeding would have the effect of prolonging my life;
  3. Cardiopulmonary resuscitation be performed if, in the opinion of my doctor, it is necessary; and
  4. Should I develop another separate condition that threatens my life, such other illness be given active treatment if, in the opinion of my doctor, such treatment is indicated.
3. If I am diagnosed as being in a persistent vegetative state and, to a reasonable degree of medical certainty, I will not regain consciousness, I direct that:
  1. I be kept on any artificial life support as long as possible within the limits of generally accepted health care standards;
  2. I receive tube feeding if necessary, even if such feeding would have the effect of prolonging my life;
  3. Cardiopulmonary resuscitation be performed if, in the opinion of my doctor, it is necessary; and
  4. Should I develop another separate condition that threatens my life, such other illness be given active treatment if, in the opinion of my doctor, such treatment is indicated.
4. If I have an advanced illness or injury that is so severe that, to a reasonable degree of medical certainty, I will not regain decision-making capacity or survive without continued life support, I direct that:
  1. I be kept on any artificial life support as long as possible within the limits of generally accepted health care standards;
  2. I receive tube feeding if necessary, even if such feeding would have the effect of prolonging my life;
  3. Cardiopulmonary resuscitation be performed if, in the opinion of my doctor, it is necessary; and
  4. Should I develop another separate condition that threatens my life, such other illness be given active treatment if, in the opinion of my doctor, such treatment is indicated.
Revocation
The authority granted in this Advance Directive may be revoked as and where permitted by law.
I understand that, as long as I have Capacity, I may revoke this Advance Directive at any time.
Statement of Values and Beliefs
________________________________________________________________________________________________________________________.
Organ Donation
I do not want my organs or tissue to be used for transplantation upon my death.
General
A copy of this Advance Directive has the same effect as the original.
If any part or parts of this Advance Directive is found to be invalid or illegal under applicable law by a court of competent jurisdiction, the invalidity or illegality of that part or parts will not in any way affect the remaining parts and this document will be construed as though the invalid or illegal part or parts had never been included in this Advance Directive. But if the intent of this Advance Directive would be substantially changed by such construction, then it shall not be so construed.
This Advance Directive is intended to be governed by the laws of the country of New Zealand.

Signature

Signed by me under hand and seal in the presence of my witness in the country of New Zealand, this ________ day of ________________, ________.

______________________________________ (Signature of the Donor)	______________________________________ (Signature of witness)
	______________________________________ (Printed name of witness)
	______________________________________ ______________________________________ ______________________________________ (Address of witness)

Record of Copies
Record of people and institutions to whom I have given a copy of this Advance Directive:

1.	________________________________________	Date: ____________________
2.	________________________________________	Date: ____________________
3.	________________________________________	Date: ____________________
4.	________________________________________	Date: ____________________
5.	________________________________________	Date: ____________________

Question Help

Living Will Document Preview

Document Preview About this Document

Our template allows you to create an Advance Directive (Living Will), an Enduring Power of Attorney (EPA) for Personal Care and Welfare, or both in one comprehensive document.

What is an Advance Directive?

An Advance Directive is a legally binding document that determines the specific medical care you wish to receive if you can no longer make medical decisions for yourself.

Doctors and healthcare workers typically request a directive to understand what treatments to provide during medical emergencies and end-of-life care.

This document is sometimes known as a Living Will because it only applies while you’re still alive, unlike a Last Will and Testament. Advance Directive is also used because people make them before old age, illness, or injury incapacitating them.

What is an Enduring Power of Attorney for Personal Care and Welfare (EPA)?

An Enduring Power of Attorney (EPA) for Personal Care and Welfare is a document that appoints someone you trust to make medical decisions when you’re incapacitated. The person you appoint is known as your attorney.

An EPA for Personal Care and Welfare works alongside your Advance Directive. Your attorney will be able to follow the instructions in your directive to make medical decisions on your behalf.

New Zealand's Protection of Personal and Property Rights Act 1988 governs EPAs for Personal Care and Welfare. Additionally, this kind of Power of Attorney shouldn’t be confused with an ordinary or enduring Power of Attorney for your financial, business, and real estate needs.

Why should I create an Advance Directive and an EPA for Personal Care and Welfare?

An Advance Directive and an EPA for Personal Care and Welfare is a key part of estate planning. It gives you control when you can’t speak for yourself and saves your family and whānau from making tough choices on your behalf.

According to the New Zealand Government, if you do not have an EPA for Personal Care and Welfare and cannot make your own decisions, your family must apply to the Family Court to have someone appointed as your welfare guardian. This process can take time and be emotionally taxing on your loved ones.

When you create an EPA for Personal Care and Welfare with your Advance Directive, you can discuss your medical intervention choices with your chosen attorney. This way, they can understand why you have made the medical decisions according to your directive. Without an Advance Directive, they will not know what treatments you do or do not want and must make those tough decisions themselves.

Decisions you can make include preferences for:

Life support
Tube feeding
Cardiopulmonary resuscitation (CPR)
Intervening illness

For example, suppose you do not want to be resuscitated in certain circumstances. In that case, you need to outline these wishes in your Advance Directive before losing capacity so that your appointed attorney can relay that information to your medical team.

If you have questions regarding Advance Directives or estate planning, contact a lawyer for more assistance.

Who can make an Advance Directive or EPA for Personal Care and Welfare (EPA)?

Anyone at least 18 years old with capacity can make an Advance Directive or EPA for Personal Care and Welfare.

Although many older people create directives, they are important documents for everyone. Unexpected medical situations and emergencies can occur at any age. Therefore, all adults should take the time to create an Advance Directive or an EPA for Personal Care and Welfare.

When does an Advance Directive and an EPA for Personal Care and Welfare apply?

The Code of Health and Disability Services Consumers' Rights outlines that your Advance Directive can only go into effect when you’re incompetent to make your own decisions. Your EPA for Personal Care and Welfare will also apply when you’re incapacitated or unable to communicate your medical decisions.

When does incapacitation occur?

A doctor will determine if you lack capacity with medical certification. For example, if someone is in the progressive stages of dementia, a doctor may determine when a patient can no longer make their own decisions.

Incapacitation occurs in situations such as:

You have an incurable or irreversible terminal condition
You’re diagnosed as persistently unconscious
You’re in a persistent vegetative state
You have an advanced illness or injury

Advance Directive versus advance care plan

An Advance Directive should not be confused with an advance care plan. Although the two documents can overlap, they are different.

An Advance Directive focuses on your treatment for medical emergencies where you cannot make those decisions yourself.

An advance care plan allows you to describe your values, religious beliefs, and anything else that will help your caregiver or medical practitioners provide your care.

How do I write an Advance Directive or an EPA for Personal Care and Welfare?

LawDepot’s customisable template allows you to make an Advance Directive or an EPA for Personal Care and Welfare. Easily follow our questionnaire and complete the steps below:

1. Determine which matters to cover in your document

You can choose to have your document cover:

Your healthcare instructions
Naming an attorney to make healthcare decisions for you
Or a combination of both

Your selection will then prompt you to include what’s next.

2. Add your details

As the donor, you’ll need to include your title, name, and contact details. You can also revoke any existing Advance Directives or EPAs for Personal Care and Welfare and replace them with your new one.

3. If desired, name your attorney

If you’re creating an EPA for Personal Care and Welfare, you’ll need to name an attorney and a successor to make medical decisions on your behalf.

Add their names, contact details, and relationship to you. You can then determine what duties and authority you give them. This can include:

If they need to consult anyone on their decisions
Providing information on their duties to someone you wish to be informed
Any limitations you want to add to their authority

4. Create a statement of values and beliefs

If it applies to your circumstances, you can include a statement of your values and beliefs. This statement specifies your beliefs and morals that may be relevant to your health care. However, it isn’t binding on doctors or health care professionals.

This statement can provide extra information that may affect your treatment if you’re hospitalized, such as your definition of quality of life or beliefs regarding specific treatments. For example, this can include a belief that no life support or prolonged, aggressive medical treatment be provided when there are no reasonable expectations of recovery.

5. Determine your treatment decisions

Next, outline your preferences for medical care. This can include treatment for:

Terminal conditions
Permanent comas
Persistent vegetative states
Advanced illness or injury

You can further decide which kind of behaviour and pain control drug treatments you would prefer to have, as well as outline any specific treatments unique to your situation.

6. Include any additional information

You can add your wishes for organ donation that can include your:

Heart
Heart valves
Lungs
Liver
Kidneys
Pancreas
Eyes
Skin

Also, include the name and details of anyone you wish to be notified if you become incapacitated.

7. Add your signing details

Finally, add a signing date if you have one chosen already or leave it blank for when you do have one.

Who can be an attorney?

When making an EPA for Personal Care and Welfare, you will appoint someone to make decisions for you if you become incapacitated. Besides being someone that you trust, your attorney must:

Be 20 years of age or older
Not be bankrupt
Is not subject to a personal or property court order
Have the capacity to make personal and welfare decisions on your behalf

You should also appoint a successor attorney who can act for you if your primary attorney is unable or unwilling to fulfil their duties.

Regardless of the duties you grant your attorney to do, there are some limitations to the powers they can receive. For example, your attorney cannot:

Consent to surgery or treatment of your brain, including electro-convulsive treatment (ECT) to change your behaviour
Allow you to take part in any medical experiment unless it might save your life or prevent serious damage to your health
Refuse consent to CPR or standard medical treatment that could save your life or prevent severe damage to you, unless otherwise outlined in your Advance Directive

You can specify that your attorney must seek advice from a particular person before making decisions. For example, you may want your attorney to consult with your family members and whānau when making critical medical decisions or moving you into a rest home.

Does my Advance Directive need to be witnessed?

An Advance Directive must have a witness who is at least 18 years old and has capacity. An EPA for Personal Care and Welfare must also be witnessed. Having a witness validates your signatures and creates more authenticity for your document when it needs to be executed.

The witness for your EPA for Personal Care and Welfare must be either:

A lawyer
A registered legal executive with at least 12 months' experience who is employed and directly supervised by a lawyer
An authorised officer or employee of a trustee corporation

The witness to your signature must also explain the effects and implications of the Power of Attorney for Personal Care and Welfare to you and answer any questions you may have. The standard explanation the witness must give is included in your document.

Can I revoke my Advance Directive or my EPA for Personal Care and Welfare?

Yes, if you’re mentally capable, you can change or revoke your Advance Directive and EPA for Personal Care and Welfare at any time. You may wish to change your directive when: