Advanced Directives (Living Will)

If a serious medical condition prevents you from communicating your treatment decisions, the responsibility for making decisions about your care will fall to your family, physician, hospital, Memorial Ambulatory Surgery Center or sometimes a court of law. Preparing an Advance Directive, however, allows you to express your wishes regarding end-of-life treatment, which will provide guidance to your family, physician, and caregivers, when you are unable to choose or refuse various types of medical care for yourself. The information on this page explains your rights to make decisions about your own health care under New Jersey Law, and your rights as a patient. It also tells you how to plan ahead for your health care if you become unable to decide for yourself because of an illness or accident.

An Advance Directive is only implemented under specific conditions, when people are determined to be unable to make health care decisions or speak for themselves. Patients must have a terminal illness or conditions that leave them in a persistent vegetative state such as severe brain damage and coma before their Advance Directive would be implemented. Some of the more common treatments people may want to address when preparing an Advance Directive include: cardiac resuscitation, respirators or breathing machines, artificial or tube feedings, renal or kidney dialysis, antibiotic treatments, blood transfusions, and surgery.

An Advance Directive can be changed at any time, and does not become effective until the time when you can no longer make medical decisions for yourself and are terminally ill. Be sure to notify your health care representative or proxy if your beliefs change and you have changed your Advance Directive.

An Advance Directive is a legal document, that anyone age 18 or older can have. It describes your medical wishes in the event that you are unable to make decisions for yourself. There are three different types of Advance Directives.

While choices concerning life and death are personal ones, they also affect the people who are close to you. For this reason, it is often helpful to discuss your medical choices with your family, friends, spiritual advisor, physicians, and proxy if you choose one. Questions about the kinds of medical procedures that are used when illness is severe and recovery unlikely can be best answered by your physician. While you may consult an attorney if you wish, it is not necessary.

Yes. Everyone responsible for your care must respect your decisions as stated in your Advance Directive. This is a legal document that must be signed, dated, and witnessed by two people. The person you choose to be your proxy or health care representative must be at least age 18. If your doctor, nurse, or other professional, however, has a sincere objection to your decision to refuse life-sustaining treatment, he or she may have your care transferred to another professional who will follow your wishes.

You should give a copy to your family physician, health care representative or proxy, family member(s), and other people who are close to you. Bring a copy when you are admitted to a hospital, nursing home or other health care facility. Your Advance Directive becomes a part of your medical record. You will be asked for a copy during each admission to ensure that the facility has the most current copy that reflects your wishes. Keep a copy of your Advance Directive in a safe place so it can be located if needed.

No. If you do not have an Advance Directive, it will in no way affect the quality of care you are provided. You do not have to fill out any of the Advance Directive forms that may be presented to you at Memorial Ambulatory Surgery Center, and you will still get medical treatment. Your insurance company cannot deny coverage based on whether or not you have an Advance Directive. Memorial Ambulatory Surgery Center does not recognize an Advance Directive for use in this setting and will use all measures possible to sustain life.

If you need assistance or would like a copy of an Advance Directive Form, please call:

Memorial Ambulatory Surgery Center provides outpatient care on a non-discriminatory basis. All patients receive care without regard to race, color, creed, disability, religion, sex, national origin, or economic status. You have the right to be notified of your rights and how to file a grievance.

1. To be informed of these rights, as evidenced by the patient’s written acknowledgement, or by documentation by staff in the medical record, that the patient was offered a written copy of these rights and given a written or verbal explanation of these rights, in terms the patient could understand. The facility shall have a means to notify patients of any rules and regulations it has adopted governing patient conduct in the facility.

2. To be informed of services available in the facility, of the names and professional status of the personnel providing and/or responsible for the patient’s care, and of fees and related charges, including the payment, fee, deposit, and refund policy of the facility and any charges for services not covered by sources of third-party payment or not covered by the facility’s basic rate.

3. To be informed if the facility has authorized other health care and educational institutions to participate in the patient’s treatment. The patient also shall have a right to know the identity and function of these institutions, and to refuse to allow their participation in the patient’s treatment.

4. To receive from the patient’s physician(s) or clinical practitioner(s), in terms that the patient understands, an explanation of his or her complete medical/health condition or diagnosis, recommended treatment options, including the option of no treatment, risk(s) of treatment, and expected result(s). If this information would be detrimental to the patient’s health, or if the patient is not capable of understanding the information, the explanation shall be provided to the patient’s next of kin or guardian. This release of information to the next of kin or guardian, along with the reason for not informing the patient directly, shall be documented in the patient’s medical record.

5. To participate in the planning of the patient’s care and treatment, and to refuse medication and treatment. Such refusal shall be documented in the patient’s medical record.

6. To be included in experimental research only when the patient gives informed, written consent to such participation, or when guardian gives such consent for an incompetent patient in accordance with the law, rule, and regulation. The patient may refuse to participate in experimental research, including the investigation of new drugs and medical devices.

7. To voice grievances or recommended changes in policies and services to facility personnel, the governing authority, and/or outside representative of the patient’s choice either individually or as a group, and free from restraint, interference, coercion, discrimination, or reprisal.

8. To be free from metal and physical abuse, free from exploitation, and free from use of restraints unless they are authorized by a physician for a limited period of time to protect the patient or others from injury. Drugs and other medications shall not be used for the discipline of patient or for convenience of facility personnel.

9. To confidential treatment of information about the patient. Information in the patient’s medical record shall not be released to anyone outside the facility without the patient’s approval, unless another health care facility to which the patient was transferred requires the information, or unless the release of the information is required and permitted by law, a third-party payment contract, or a peer review, or unless the information is needed by the New Jersey State Department of Health for statutorily authorized purposes. The facility may release data about the patient for studies containing aggregated statistics when the patient’s identity is masked.

10. To be treated with courtesy, consideration, respect, and recognition of the patient’s dignity, individuality, and the right to privacy, including, but not limited to, auditory and visual privacy. The patient’s privacy shall also be respected when the facility personnel are discussing the patient.

11. To not be required to perform work for the facility unless the work is part of the patient’s treatment and is performed voluntarily by the patient. Such work shall be in accordance with local, state and federal laws and rules.

12. To exercise civil and religious liberties, including the right to independent personal decisions. No religious beliefs or practices, or any attendance at religious services, shall be imposed upon any patient.

13. To not be discriminated against because of age, race, religion, sex, nationality, or deprived of any constitutional, civil, and/or legal rights solely because of receiving services from the facility.

14. To expect and receive appropriate assessment, management and treatment of pain as an integral component of that person’s care in accordance with N.J.A.C. 8:43E-6.

To present questions or grievance to a designated Memorial Ambulatory Surgery Center staff member and to receive a response in a reasonable period of time. Memorial Ambulatory Surgery Center must provide you with the address and telephone number of the New Jersey Department of Heath Agency that handles questions and complaints. You may directly contact the New Jersey Department of Health Complaint Hotline at 1-800-792-9770, or contact Medicare directly at their website www.medicare.gov, or you may contact Memorial Ambulatory Surgery Center’s Administrator at 609-265-7800. This list of Patient Rights is an abbreviated summary of the current New Jersey law and regulations governing the rights of Ambulatory Care patients. For more complete information consult New Jersey Department of Health regulations at N.J.A.C. 8:43A-16.2 available through the Administration Office at Memorial Ambulatory Surgery Center Administrator at 609-265-7800.

Thanks for Cooperating

To provide quality care and treatment requires each patient’s cooperation. You, as the patient, are responsible to: