DURABLE POWER OF ATTORNEY FOR HEALTH CARE
I, CHARLES T. WOLFRAM, hereby appoint MARY A. WOLFRAM, to serve as my agent ("agent") and to exercise the powers set forth below. If she should fail to qualify or cease to act, I then appoint my son, CHARLES W. WOLFRAM, to seve as my agent ("agent") to exercise the powers set forth below.
By this document, I intend to create a Durable Power of Attorney for Health Care. If no agent designated in this document is available or able to serve, I request that my desires as expressed in this document be given full force and effect as a written expression of intent under applicable law.
This document is effective upon and only during any period of incapacity in which, in the opinion of my agent and attending physician, I am unable to make or communicate a choice regarding a particular health care decision. A determination of competence under this provision is strictly for the purpose of implementing this advance directive and shall not be construed as a determination of competence for any other purpose. This document shall not be affected by any subsequent incapacity or disability.
I desitre that my wishes as expressed herein be carried out through the authority given to my agent by this document despite any contrary feelings, beliefs or opinions of members of my family, relatives, friends, conservator or guardian.
ARTICLE ONE: MY AGENT'S GENERAL POWERS REGARDING MY HEALTH CARE
My agent is authorized in my agent's sole and absolute discretion to exercise the powers granted herein relating to matters involving my health care and medical care, In exercising such powers, my agent should first try to discuss with me the specifics of anty proposed decision regarding my medical care and treatment if I am able to communicate in any manner, however rudimentary. My agent is further instructed that if I am unable to give an informed consent to a proposed medical treatment, my agent shall give, withhold or withdraw such consent for me based upon any treatment choices that I have expressed while competent, whether under this document or otherwise. If my agent cannot determine the treatment choice I would want made under the circumstances, then my agent should make such choice for me based upon what my agent believes to be in my best interests. Accordingly, my agent is authorized as follows:
A. Gain Access to Medical Records and Other Personal Information. To request, receive and review any information, verbal or written, regarding my personal affairs or my physical or mental health, including medical and hospital records, and to execute any release or other documents that may be required in order to obtain such information, and to disclose such information to such persons, organizations, firms or corporations as my agent shall deem appropriate.
B. Employ and Discharge Health Care Personnel. To employ and discharge medical personnel, including physicians, psychiatrists, dentists, nurses and therapists as my agent shall deem necessary for my physical, mental and emotional well being, and to pay them (or cause to be paid to them) reasonable compensation.
C. Give, Withhold or Withdraw Consent to Medical Treatment. To give or withhold consent to any medical procedure, test or treatment, including surgery; to arrange for my hospitalization, convalescent care, hospice or home care; to summon paramedics or other emergency medical personnel and seek emergency treatment for me, as my agent shall deem appropriate; and under circumstances in which my agent determines that certain medical procedures, tests or treatments are no longer of any benefit to me or, where the benefits are outweighed by the burdens imposed, to revoke, withdraw, modify or change consent to such procedures, tests and treatments, as well as hospitalization, convalescent care, hospice or home care which I or my agent may have previously allowed or consented toor which may have been implied due to emergency conditions. My agent's decisions should be guided by taking into account (1) the provisions of this document, (2) any reliable evidence of preferences that I may have expressed on the subject, whether before or after the execution of this document, (3) what my agent believes I would want done in the circumstance if I were able to express myself, and (4) any information given to my agent by the physicians treating me as to my medical diagnosis and prognosis, with the intrusiveness, pain, risks and side effects associated with the treatment.
D. Exercise and Protect my Rights. To exercise my right of privacy and my right to make decisions regarding my medical treatment even though the exercise of my rights might hasten my death or be against conventional medical advice.
E. Authorize Relief from Pain. To consent to and arrange for the administration of pain-relieving drugs of any kind or other surgical or medical procedures calculated to relieve my pain, including unconventional pain-relief therapies which my agent believes may be helpful, even though such drugs or procedures may lead to permanent physical damage, or hasten the moment of (but not intentionally cause) my death.
F. Grant Release. To grant, in conjunction with my instructions given under this Article, releases to hospital staff, physicians, nurses and other medical and hospital administrative personnel who act in reliance on instructions given by my agent or who render written opinions to my agent in connection with any matter described in this Article from all liability or damages suffered or to be suffered by me; to sign documents titled or purporting to be a "Refusal of Treatment" or "Leaving Hospital Against Medical Advice" as well as any necessary waivers of or releases from liability required by a hospital or physician to implement my wishes regarding medical treatment or non-treatment.
ARTICLE TWO: MY AGENT'S POWERS REGARDING LIFE SUSTAINING MEDICAL TREATMENT
I wish to live and enjoy life as long as possible. However, I do not wish to receive medical treatment which will only postpone the moment of my death
from an incurable and terminal condition or prolong an irreversible coma. For the purposes of this document, (1) "terminal condition" shall refer to a condition that is reasonably expected to result in death within twelve (12) months regardless of the treatment that I may receive and (2) "irreversible coma" shall refer to a loss of consciousness from which there is no reasonable possibility that I will return to a cognitive and sapient life, and shall include, but not be limited to, a persistent vegitative state.
Therefore, if two (2) licensed and qualified physicians who are familar with my condition have diagnosed and noted in my medical records that:
(1) I am unable to give informed consent to medical treatment that is proposed or available for my condition and my condition is terminal as defined above, or
(2) I have been in a coma and that coma is irreversible as defined above, then my agent is authorized to:
(a) direct that treatmrent or procedures which will only postpone the moment of my death or prolong an irreversible coma be withheld or, if previously instituted, direct that they be withdrawn;
(b) direct that procedures other than medical feeding used to provide me with nourishment and hydration (including, for example all forms of intravenous and parenteral feeding, all forms of tube feeding, and misting) be withheld or, if previously instituted, to direct that they be withdrawn;
(c) sign on my behalf any documents necessary to carry out the powers granted in this Article (including waivers or releases of liability required by any health care provider);
(d) direct and consent to the writing of a "No Code" or "Do Not Resuscitate" order by any health care provider; and
(e) order whatever is appropriate to keep me as comfortable and free of pain as is reasonably possible, including the administration of pain relieving drugs, surgical or medical procedures calculated to relieve my pain, and unconventional pain-relief therapies which my agent believes may be helpful, even though such drugs or procedures may lead to permanent physical damage, addiction or hasten the moment of (but not intentionally cause) my death.
In exercising the powers given my agent under this Article, my agent shall follow the instructions of this document and any other subsequent instructions, oral or written, that I may give my agent while I am competent. Notwithstanding such instructions, if my agent cannot determine the treatment choice I would want made under the circumstances, them (sic) my agent should make such choices for me based upon what my agent believes to be in my best interest.
I CERTIFY THAT I HAVE READ THE PROVISIONS OF THIS ARTICLE DIRECTING MY AGENT TO REFUSE MEDICAL TREATMENT FOR ME UNDER THE CIRCUMSTANCES SPECIFIED IN THIS ARTICLE, THAT SUCH PROVISIONS HAVE BEEN EXPLAINED TO ME TO MY SATISFACTION, THAT I UNDERSTAND SUCH PROVISIONS, AND THAT SUCH PROVISIONS STATE MY WISHES AND DESIRES UNDER THE CIRCUMSTANCES. Charles T Wolfram
ARTICLE THREE: MY AGENT'S POWERS REGARDING MY CARE AND CONTROL OF MY BODY
My agent is authorized as follows with respect to my care and the control of my body:
A. Provide for my Residence. To make all necessary arrangements for me at any hospital, hospice, nursing home, convalescent hpme or similar establishment and to assure that all my essential needs are provided for at such facility.
B. Provide for Companionship. To provide for such companionship for me as will meet my needs and preferences at a time when I am disabled or otherwise unable to arrange for such companionship myself.
C. Make Advance Funeral Arrangements. To make advance arrangements for my funeral and burial, including the purchase of a burial plot and marker, and such other related arrangements as my agent shall deem appropriate, if I have not already done so myself.
D. Make Anatomical Gifts. To make anatomical gifts which will take effect at my death to such persons and organizations as my agent shall deem appropriate and to execute such papers and do such acts as shall be necessary, appropriate, incidental or convenient in connection with such gifts.
ARTICLE FOUR: THIRD PARTY RELIANCE
For the purposes of inducing any individual, organization or entity, (including, but not limited to any physician, hospital, nursing home, insurer or other party, all of whom will be referred to in this Article as a "person") to act in accordance with the instructions of my agent as authorized in this documents, I hereby represent, warrant and agree that:
A. Reliance on Agent's Authority and Representations. No person who relies in good faith upon the authority of my agent under this document shall incur any liability to me, my estate, my heirs, successors or assigns. In addition, no person who relies in good faith upon any representation my agent shall make as to (a) the fact that my agent's powers are then in effect, (b) the scope of my aggent's authority granted under this document, (c) my competency at the time this document is executed, (d) the fact that this document has not been revoked, or (e) the fact that my agent continues to serve as my agent shall incur any liability to me, my estate, my heirs, successors or assigns for permitting my agent to exercise any such authority.
B. No Liability for Unknown Revocation or Amendment. If this document is revoked or amended for any reason, I, my estate, my heirs, successors, and assigns wil hold any person harmless from any loss suffered or liability incurred as a result of such person acting in good faith upon the instructions of my agent prior to the receipt by such person of actual notice of such revocation or amendment.
C. My Agent May Act Alone. The powers conferred on my agent by this document may be exercised by my agent alone and my agent's signature or act under the authority granted in this document may be accepted by persons as fully authorized by me and with the same force and effect as if I were personally present, competent, and acting on my own behalf. Consequently, all acts lawfully done by my agent hereunder are done with my consent, and shall hve the same validity aand effect as if I were personally present and personally exerciseed the powers myself, and shall inure to the benefit of and bind me, my estate, my heirs, successors, assigns and personal representatives.
D. Release of Information. I hereby authorize all physsicians and psychiatrists who have treated me, and all other providers of health care, including hospitals, to release to my agent all information or photocopies of any records which my agent may request. If I am incompetent at the time my agent shall request such information, all persons are authorized to treat any such requestfor information by my agents as the request of my legal representative and to honor such requests on that basis. I hereby waive all privileges which may be applicable to such information and records and to any communication pertaining to me and made in the course of any confidential relationship recognized by law. My agent may also disclose such information to such persons as my agent shall deem appropriate.
E. Resort to Courts. I hereby authorize my agent to seek on my behalf and at my expense:
(a) a declaratory judgement from any court of compentent jurisidiction interpreting the validity of this document or any of the acts authorized by this document, but such declaratory judgement shall not be necessary in order for my agent to perform any act authorized by this document; or
(b) a mandatory injunction requiring compliance wth my agent's instructions by any person obligated to comply with instructions given by my agent; or
(c) actual and punitive damages against any person obligated to comply with instructions given by my agent who negligently or willfully fails or refuses to follow such instructions.
ARTICLE FIVE: MISCELLANEOUS PROVISIONS
The following additional provisions shall apply to this document:
A. Reimbursement of Costs. My agent shall be entitled to reimbursement for all reasonable costs and expenses actually incurred and paid by my agent on my behalf under any provision of this document but my agent shall not be entitled to compensation for services rendered hereunder.
B. Execute Documents and Incur Costs in Implementing the Above Powers. My agent shall be entitled to sign, execute, delver, and acknowledge any contract or other document that may be necessary, desirable, convenient or proper in order to exercise any of the powers described in this document and to incur reasonable costs in the exercise of any such power. In addition, my agent shall render bills for all costs incurred in the exercise of the powers granted in this document to the person handling my financial affairs under any document I have signed.
C. Nomination of Representative. To the extent that I am permitted by law to do so, I hereby nominate my agent to serve as my guardian, conservator or in any similar representative capicity, and if I am not permitted by law to so nominate than I request in the strongest possible terms that any court of competent jurisdiction which may receive and be asked to act upon a petition by any person to appoint a guardian, conservator or otheer similar representative for me give the greatest possible weight to this request.
D. Governing Law. This document shall be governed by the law of the State of New Jersey in all respects, including its validity, construction, interpretation and termination. I intend for this Durable Power of Atorney for Health Care to be honored in any jurisdiction where it may be presented and for any such jurisdiction to refer to New Jersey law to interpret and determine the validity of this document and any of the powers granted under this document.
E. Revocation and Amendment. I revoke all prior Durable Powers of Attorney for Health Care that I may have executed and I retain the right to revoke or amend this document and to substitute other agents in their place. Amendments to this shall be made in writing by me personally and they shall be attached to he original of this document.
F. Resignation of Agent. My agent and any alternative agent may resign by the executuion of a written resignation delivered to any person with whom I am residing or who has the care and custody of me, or the next agent listed in order on page one.
In addition, the incapacity of my agent or any alternative agent shall be deemed as a resignation by such individual as agent or alternative agent as the case may be. For purposes of this paragraph, a person's incapacity shall be deemed to exist when the person's incapacity has been declared by a court of competent jurisdiction, or when a conservator from such a person has been appointed, or upon presentation of a certificate executed by two (2) physicians licensed to practice in the state of such person's residence which states the physicians' opinion that the person is incapable of caring for himself or herself and is physically or mentally incapable of managing his or her personal or financial affairs. The effective date of such incapacity shall be the date of the decree adjudicating the incapacity, the date of the decree appointing the conservator, or the date of the physicians' certificate, as the case may be.
G. Photocopies. My agent is authorized to make photocopies of this document as frequently and in such quantity as my agent shall deem appropriate. I specifically direct my agent to have a photocopy of this document placed in my medical records if such a copy does not already constitute a part of my medical records.
H. Serverability. If any part of any provision of this document shall be invalid or unenforceable under applicable law, such part shall be ineffective to the extent of such validity only without in any way affecting the remaining parts of such provision or the remaining provisions of this document.
I. Exculpation. My agent and my agent's estate, heirs, successors and assigns are hereby released and forever discharged by me, my estate, my heirs, successors and assigns from all liability and from all claims or demands of all kinds arising out of the acts or omissions of my agent, except for willful misconduct or gross negligence.
I execute this Durable Power of Attorney for Health Care on this 19 day of May, 1992.
Rachell M Fanuci Charles T Wolfram
Witness CHARLES T. WOLFRAM
Joanne C. Lowry
STATE OF NEW JERSEY:
COUNTY OF ATLANTIC: ss.
Subscribed, sworn to and acknowledged before me by CHARLES T. WOLFRAM, and subscribed and sworn to before me by Rachell M Fanucci, and Joann C. Lowry, the witnesses, this 19th day of May, 1992.
(SEAL) Esther Jo DaGosa
ESTHER J. DaGROSA
NOTARY PUBLIC OF NEW JERSEY
My Commission Expires Aug. 18, 1992.