LIVING WILL AND ADVANCE DIRECTIVE OF JONATHAN ROBERT CALDWELL
Declaration Made Pursuant to New York Law
Executed April 1, 2023
I. DECLARANT IDENTIFICATION AND PREAMBLE
I, Jonathan Robert Caldwell, born March 14, 1956, a resident of the State of New York, currently residing at 418 East 72nd Street, Apt. 14A, New York, New York 10021, Social Security Number ending in 4781, being of sound mind and acting of my own free will, without coercion, duress, or undue influence of any kind, do hereby make this Living Will and Advance Directive to provide written instructions regarding my wishes for medical treatment and end-of-life care in the event that I become unable to communicate such wishes personally, whether by reason of illness, injury, incapacity, or any other cause.
I make this declaration with full knowledge and understanding of its contents, implications, and legal significance. I have given careful and prolonged thought to the matters addressed herein, and I have had the opportunity to consult with my attorneys, my physicians, and members of my immediate family before executing this document.
This Living Will and Advance Directive is intended to supplement, and not to conflict with, the Health Care Proxy of Jonathan R. Caldwell that I have executed on this same date, April 1, 2023, pursuant to the laws of the State of New York. That Health Care Proxy designates my wife, Eleanor Victoria Caldwell, as my primary health care agent, and my daughter, Katherine C. Hartfield, as my successor health care agent. To the extent that any provision of this Living Will may appear to conflict with my Health Care Proxy, this Living Will shall be read harmoniously with the Health Care Proxy, and my health care agent shall exercise her best judgment in resolving any such ambiguity in a manner consistent with the values, preferences, and intentions expressed herein.
I wish to state for the record that I have discussed the contents, directives, and spirit of this Living Will in detail with my beloved spouse, Eleanor Victoria Caldwell, and with my three adult children: Thomas R. Caldwell, Katherine C. Hartfield, and Olivia G. Caldwell. Each of them is aware of my wishes and the reasons underlying these wishes. I am satisfied that my family understands and, while they may hold personal views of their own, respects my right to make these decisions for myself.
I intend this document to be given the fullest possible legal effect under the laws of the State of New York and, to the extent applicable, under the laws of any other jurisdiction in which I may receive medical care.
II. DEFINITIONS
As used in this Living Will and Advance Directive, the following terms shall have the meanings set forth below:
"Attending Physician" shall mean the physician who has primary responsibility for my medical care at the time any decision under this directive must be made, whether such physician is employed by a hospital, a long-term care facility, a home health agency, or is in private practice.
"Terminal Condition" shall mean an incurable and irreversible condition that, in the opinion of two (2) or more licensed physicians who have personally examined me, will result in my death within a relatively short period of time regardless of the application or continuation of medical treatment. A condition shall be deemed "terminal" only when the application of life-sustaining treatment would serve only to prolong the dying process and would not result in the cure or remission of the underlying condition.
"Permanent Unconsciousness" shall mean a condition in which I am in a persistent vegetative state or an irreversible coma, as certified by two (2) or more licensed physicians who have personally examined me, with no reasonable medical expectation of my regaining consciousness. This definition includes, but is not limited to, conditions diagnosed as persistent vegetative state, permanent vegetative state, and irreversible coma, as those terms are understood in current medical practice.
"Life-Sustaining Treatment" shall mean any medical procedure, device, intervention, or medication that serves primarily to prolong the process of dying or to maintain me in a state of permanent unconsciousness, rather than to cure, ameliorate, or provide comfort for an underlying condition. Life-sustaining treatment includes, but is not limited to, the following:
(a) mechanical ventilation and artificial respiration;
(b) cardiopulmonary resuscitation (CPR), including chest compressions, defibrillation, and advanced cardiac life support;
(c) artificial nutrition and hydration, including nutrition and fluids delivered by nasogastric tube, gastrostomy tube (PEG tube), jejunostomy tube, intravenous line, subcutaneous infusion (hypodermoclysis), or any other artificial means;
(d) renal dialysis or kidney replacement therapy of any kind;
(e) blood transfusions and blood product administration;
(f) the administration of antibiotics, antiviral agents, or other medications intended solely to prolong life rather than to provide comfort; and
(g) any surgical or invasive procedure intended primarily to prolong life rather than to relieve pain or provide comfort.
"Palliative Care" shall mean treatment directed at controlling pain, managing symptoms, and providing comfort to me, rather than at curing or treating the underlying disease or condition. Palliative care includes, without limitation, the administration of medication for pain relief, sedation for comfort, management of nausea, respiratory distress, and anxiety, and the provision of emotional, psychological, and spiritual support. Palliative care expressly includes the administration of analgesic and sedative medications even if such medications may have the secondary effect of suppressing respiration, hastening unconsciousness, or hastening death, provided that the primary intent of such administration is the relief of pain and suffering.
"Health Care Agent" shall mean the person designated under my Health Care Proxy, executed on April 1, 2023, to make health care decisions on my behalf when I am unable to do so. My primary health care agent is Eleanor V. Caldwell. My successor health care agent, who shall serve if Eleanor V. Caldwell is unable, unwilling, or unavailable to serve, is Katherine C. Hartfield.
III. GENERAL STATEMENT OF INTENT
I, Jonathan Robert Caldwell, value the quality of life and personal dignity above the mere prolongation of biological existence. I have lived a full and meaningful life, and I believe that there are circumstances under which the continuation of medical treatment serves no purpose other than to delay the inevitable and to impose unnecessary suffering upon me and upon those who love me.
If, at any time, I am diagnosed with a terminal condition, as defined herein, or if I am in a state of permanent unconsciousness, as defined herein, I do not wish to have my life prolonged by artificial, extraordinary, or heroic means. I wish my death not to be artificially postponed. I desire to be permitted to die naturally, with dignity, surrounded by comfort and, if possible, by the presence and love of my family.
I recognize that medical science continues to advance and that treatments that may seem extraordinary today may become commonplace in the future. I have considered this reality, and I nonetheless wish the directives set forth herein to be honored unless I have revoked or amended them. I trust my health care agent and my family to consider the circumstances prevailing at the time any decision must be made and to apply these directives in a manner that is consistent with my fundamental values.
I understand that this directive may be revoked at any time by me, through oral or written communication, as more fully described in Section IX of this document. Until such revocation, I intend these directives to be binding upon my health care agent, my attending physician, and any hospital, nursing facility, hospice, or other health care provider responsible for my care.
IV. SPECIFIC DIRECTIVES REGARDING LIFE-SUSTAINING TREATMENT
A. Terminal Condition
If I am diagnosed with a terminal condition, as defined in Section II of this Living Will, and such diagnosis has been confirmed by two (2) or more licensed physicians who have personally examined me, I direct that the following measures be taken, or withheld, as specified:
1. Mechanical Ventilation and Artificial Respiration. I direct that mechanical ventilation and artificial respiration be withheld or, if already initiated, withdrawn. I do not wish to be placed on a ventilator or any other device that artificially sustains respiratory function if such treatment serves only to prolong the dying process.
2. Cardiopulmonary Resuscitation. I direct that no cardiopulmonary resuscitation (CPR) be performed if I experience cardiac arrest or respiratory arrest. This includes, without limitation, chest compressions, electrical defibrillation, endotracheal intubation, and the administration of cardiac resuscitation drugs. I wish that a Do Not Resuscitate (DNR) order be entered in my medical record and honored by all treating physicians and health care providers.
3. Artificial Nutrition and Hydration. I direct that artificial nutrition and hydration, including nutrition and fluids delivered by nasogastric tube, gastrostomy tube (PEG tube), intravenous line, or any other artificial means, be withheld or withdrawn, unless my attending physician, in consultation with my health care agent, determines that the provision of such nutrition or hydration is necessary solely to maintain my comfort and to prevent suffering from hunger or thirst. If oral nutrition and hydration can be provided safely and comfortably, such oral care may continue.
4. Dialysis and Kidney Replacement Therapy. I direct that no renal dialysis, hemodialysis, peritoneal dialysis, or other kidney replacement therapy be initiated on my behalf. If I am currently receiving dialysis at the time of the diagnosis of a terminal condition, I direct that such treatment be discontinued.
5. Surgical Procedures. I direct that no surgical procedures be performed on my behalf if such procedures are intended solely to prolong my life. This does not include minor procedures that may be necessary to provide comfort or to manage pain.
6. Antibiotics and Medications. I direct that antibiotics, antiviral agents, and other medications may be administered to me only for purposes of comfort and symptom management, and not for the purpose of prolonging the dying process. If an infection develops and treating that infection would serve only to extend the period of dying, I do not wish to receive antibiotic treatment. However, if an infection is causing me discomfort or suffering, antibiotics may be administered to the extent necessary to relieve such discomfort.
7. Blood Transfusions. I direct that blood transfusions and blood product administration may be withheld if such transfusions serve primarily to prolong the dying process rather than to enhance my comfort. If a transfusion would be expected to relieve specific symptoms that are causing me distress, such as severe anemia-related shortness of breath, my health care agent may, in consultation with the attending physician, authorize such transfusion for comfort purposes.
B. Permanent Unconsciousness
If I am diagnosed as being in a state of permanent unconsciousness—whether described as a persistent vegetative state, a permanent vegetative state, or an irreversible coma—and such diagnosis has been certified by two (2) or more licensed physicians who have personally examined me and who have determined that there is no reasonable medical expectation that I will regain consciousness, I direct that the following measures be taken:
1. Withdrawal of All Life-Sustaining Treatment. All life-sustaining treatment, as defined in Section II of this Living Will, shall be withheld or withdrawn. My care shall be limited to palliative and comfort measures only.
2. Artificial Nutrition and Hydration. Artificial nutrition and hydration shall be withdrawn after a reasonable observation period following the certification of permanent unconsciousness. This observation period shall not exceed fourteen (14) calendar days from the date on which two qualified physicians have certified my condition as permanently unconscious, unless my attending physician determines, in consultation with my health care agent, that a longer observation period is medically warranted based on the specific clinical circumstances of my case. In no event shall artificial nutrition and hydration be continued indefinitely if the medical consensus is that I have no reasonable prospect of recovering consciousness.
3. Mechanical Ventilation. Mechanical ventilation and artificial respiration shall be withdrawn. If I am dependent upon a ventilator, the withdrawal shall be conducted in a medically appropriate manner, with adequate sedation and pain management to ensure my comfort during the process.
4. Cardiopulmonary Resuscitation. No cardiopulmonary resuscitation (CPR) shall be performed under any circumstances. A Do Not Resuscitate (DNR) order shall be entered and maintained in my medical record.
5. Limitation of Treatment to Comfort Measures. All treatment shall be limited to palliative care and comfort measures as defined in Section II of this Living Will. This includes the provision of oral care, hygiene, management of skin integrity, and the administration of medication for any distress or discomfort, even if the source of such discomfort is uncertain given my unconscious state.
C. Advanced Dementia or Irreversible Cognitive Decline
I recognize that I may, in the course of aging or illness, develop a progressive and irreversible cognitive decline such as that caused by Alzheimer's disease, frontotemporal dementia, or other neurodegenerative conditions. I wish to provide specific guidance for such circumstances.
If I am diagnosed by two (2) or more licensed physicians as having advanced, irreversible dementia to the degree that I can no longer recognize the members of my family, can no longer communicate meaningfully by any means, and can no longer perform the basic functions of daily living without complete assistance, I direct the following:
1. Cardiopulmonary Resuscitation. I do not wish to receive cardiopulmonary resuscitation (CPR) under any circumstances. A DNR order shall be entered and maintained.
2. Mechanical Ventilation. I do not wish to be placed on mechanical ventilation or any form of artificial respiration.
3. Artificial Nutrition and Hydration. I do not wish to receive artificial nutrition and hydration by any means, including nasogastric tube, gastrostomy tube, intravenous line, or subcutaneous infusion. Oral feeding and hydration may be offered as tolerated, but I do not wish to receive artificial means of sustaining nutrition if I am no longer able to eat or drink safely by mouth.
4. Comfort-Focused Care. I wish to receive comfort-focused care only, directed at managing pain, providing physical comfort, and maintaining dignity.
5. Deference to Health Care Agent. With respect to medical decisions not specifically addressed in this subsection—including, but not limited to, the appropriateness of administering antibiotics for infections, the advisability of hospitalization versus treatment in place, and the use of other medical interventions—I defer to the judgment of my health care agent, Eleanor V. Caldwell, or, if she is unable, unwilling, or unavailable to serve, my successor health care agent, Katherine C. Hartfield. I trust my health care agent to exercise such judgment in consultation with my attending physician and in a manner consistent with the values and preferences I have expressed throughout this document and in our personal conversations.
V. PALLIATIVE CARE AND PAIN MANAGEMENT
Under all circumstances described in this Living Will and Advance Directive—whether I am diagnosed with a terminal condition, a state of permanent unconsciousness, advanced dementia, or any other condition in which the directives of this document are applicable—I wish to receive full palliative care and comprehensive pain management. The following provisions reflect my deeply held wishes regarding comfort care:
1. Medication for Pain Relief. I authorize and direct my attending physician and all health care providers responsible for my care to administer medication for pain relief in whatever type, combination, and dosage is necessary to keep me comfortable and free from pain, even if such medication may have the effect of suppressing respiration, hastening unconsciousness, or hastening my death. I understand the medical principle of double effect, and I expressly consent to the use of analgesic and sedative medications under this principle, provided that the primary intent of such administration is the relief of my pain and suffering.
2. Comfort and Dignity. I wish to be kept clean, warm, and as free from pain, distress, and indignity as possible. I request that my caregivers provide attentive hygiene, including oral care, skin care, and repositioning as needed to prevent discomfort. I wish my physical surroundings to be as comfortable and peaceful as circumstances allow.
3. Spiritual, Emotional, and Psychological Support. I desire to receive spiritual, emotional, and psychological support as appropriate and consistent with my personal wishes and the traditions of my family. I have been a lifelong Episcopalian, and I would welcome the visits and prayers of a member of the clergy, if available. I also welcome the presence and comfort of my family, friends, and any other persons whom my health care agent deems appropriate.
4. Setting of Care and Family Presence. I wish, if practicable and consistent with the provision of appropriate medical care, to be in the company of my family at the time of my death. I express a strong preference to die at home—at my residence at 418 East 72nd Street, Apt. 14A, New York, New York—or, if that is not feasible, in the most homelike setting available, such as an inpatient hospice facility. I prefer not to die in a hospital intensive care unit if that can reasonably be avoided. I request that my health care agent and my family work with my medical team to facilitate this preference.
5. Hospice Care. I authorize and encourage my health care agent to enroll me in a hospice program when such enrollment is medically appropriate, and I consent to the provision of hospice care in my home or in a hospice facility.
VI. ORGAN AND TISSUE DONATION
I have given thoughtful consideration to the matter of organ and tissue donation, and I hereby express my wishes as follows:
1. Consent to Donation. I wish to make available any of my organs and tissues for transplantation upon my death, if such organs and tissues are medically suitable for transplantation. This includes, without limitation, my heart, lungs, liver, kidneys, pancreas, intestines, corneas, skin, bone, tendons, heart valves, and any other organs or tissues that may be of benefit to living recipients.
2. Authority of Health Care Agent. I authorize my health care agent, Eleanor V. Caldwell, or my successor health care agent, Katherine C. Hartfield, to consent to organ and tissue donation on my behalf and to make any decisions necessary to facilitate such donation, including decisions regarding the specific organs or tissues to be donated and the recipients or organizations to receive them.
3. Temporary Maintenance of Life-Sustaining Treatment for Organ Preservation. I recognize that organ donation may, in certain circumstances, require the temporary maintenance of life-sustaining treatment after the determination of my death, solely for the purpose of preserving the viability of organs and tissues for transplantation. I consent to such temporary measures for a period not to exceed twenty-four (24) hours following the determination of my death, provided that such measures are undertaken solely for the purpose of organ preservation and not for any other purpose. After the expiration of this twenty-four-hour period, or upon the completion of organ recovery, whichever occurs first, all life-sustaining treatment shall be discontinued.
4. No Conflict with End-of-Life Directives. Nothing in this Section VI shall be construed to require the initiation, continuation, or restoration of life-sustaining treatment that I have directed to be withheld or withdrawn under Sections IV or V of this Living Will, except as expressly provided in paragraph 3 of this Section VI regarding the temporary preservation of organs following the determination of death.
VII. RELATIONSHIP TO HEALTH CARE PROXY
This Living Will and Advance Directive is intended to supplement and operate in conjunction with my Health Care Proxy, executed on this same date, April 1, 2023, pursuant to Article 29-C of the New York Public Health Law. The Health Care Proxy designates the following individuals:
Primary Health Care Agent: Eleanor V. Caldwell, residing at 418 East 72nd Street, Apt. 14A, New York, New York 10021.
Successor Health Care Agent: Katherine C. Hartfield, residing at 210 Briarcliff Lane, Greenwich, Connecticut 06830.
I direct that my health care agent give full effect to the wishes expressed in this Living Will when making health care decisions on my behalf. The directives contained herein represent my settled, considered wishes, arrived at after careful reflection and discussion with my family, my attorneys, and my physicians. My health care agent should treat these directives as binding expressions of my will, not merely as suggestions or guidelines.
In the event of any ambiguity in the provisions of this Living Will, or in the event of a medical situation not specifically addressed by the directives set forth herein, I direct that my health care agent exercise her best judgment in accordance with my overall values and preferences as expressed in this document and as known to her through our personal discussions over the course of our marriage and family life. I have the utmost confidence in the judgment, compassion, and integrity of my wife, Eleanor V. Caldwell, and of my daughter, Katherine C. Hartfield, and I trust them to make decisions that honor my dignity, my values, and my wishes.
In connection with the execution of this Living Will, my Health Care Proxy, and my estate planning documents, I have also executed a HIPAA Authorization on April 1, 2023, pursuant to the Health Insurance Portability and Accountability Act of 1996, as amended. That HIPAA Authorization permits the disclosure of my protected health information to the following individuals, to enable them to participate meaningfully in health care decisions on my behalf:
(a) Eleanor V. Caldwell, 418 East 72nd Street, Apt. 14A, New York, New York 10021;
(b) Thomas R. Caldwell, 55 Perry Street, Unit 3, New York, New York 10014;
(c) Katherine C. Hartfield, 210 Briarcliff Lane, Greenwich, Connecticut 06830; and
(d) Olivia G. Caldwell, 1240 North Dearborn Street, Apt. 807, Chicago, Illinois 60610.
I request that my physicians and health care providers honor the HIPAA Authorization in full and share relevant medical information with the above-named individuals as necessary to facilitate informed decision-making regarding my care.
VIII. COMMUNICATION OF WISHES TO PHYSICIANS AND HEALTH CARE PROVIDERS
I request that a copy of this Living Will and Advance Directive be placed in my permanent medical record maintained by my primary care physician and by any hospital, nursing facility, hospice, or other health care institution at which I receive care. I further request that my health care agent provide a copy of this document to any physician or health care provider who assumes responsibility for my care.
I direct my attending physician and all health care providers responsible for my treatment to honor the terms and directives of this Living Will in full. If my attending physician, or any other physician or health care provider, is unwilling or unable to comply with the directives set forth herein—whether for reasons of personal conscience, institutional policy, or otherwise—I respectfully but firmly direct that such physician or provider promptly transfer my care to another qualified physician or provider who is willing to honor these wishes. The transfer shall be accomplished as expeditiously as possible and without interruption of necessary comfort care.
I, Jonathan Robert Caldwell, hereby release, hold harmless, and agree to indemnify any physician, hospital, health care facility, nursing home, hospice, or other health care provider, and their respective officers, directors, employees, and agents, who act in good faith reliance upon the directives and provisions of this Living Will and Advance Directive, from any and all liability, claims, damages, or causes of action arising from such reliance, to the fullest extent permitted by applicable law. I intend this release to cover both the withholding and the withdrawal of life-sustaining treatment in accordance with my expressed wishes.
IX. REVOCATION
I reserve the right to revoke this Living Will and Advance Directive at any time, in whole or in part, regardless of my physical or mental condition at the time of such revocation. I may revoke this document by any of the following means:
(a) executing a signed, written revocation, whether or not witnessed or notarized;
(b) making an oral statement expressing my intent to revoke this directive, in the presence of at least one (1) witness;
(c) physically destroying this document or directing another person to destroy it in my presence; or
(d) executing a new Living Will or Advance Directive, which shall supersede this document to the extent of any inconsistency.
A revocation shall be effective upon its communication to my attending physician or to any health care provider responsible for my care. Upon receipt of notice of revocation, my attending physician or health care provider shall promptly record the revocation in my medical record and take all steps necessary to give effect to the revocation.
Until such revocation is communicated, this Living Will shall remain in full force and effect.
X. SEVERABILITY
If any provision of this Living Will and Advance Directive is held by a court of competent jurisdiction or by operation of law to be invalid, illegal, or unenforceable under the laws of the State of New York or any other applicable jurisdiction, such invalidity, illegality, or unenforceability shall not affect the validity, legality, or enforceability of the remaining provisions of this document. The remaining provisions shall continue in full force and effect and shall be construed and enforced as if the invalid, illegal, or unenforceable provision had never been included herein. It is my express intent that each provision of this Living Will be treated as independent and severable from every other provision.
XI. GOVERNING LAW
This Living Will and Advance Directive shall be governed by and construed in accordance with the laws of the State of New York, without regard to principles of conflicts of law. To the extent that I am receiving medical care in a jurisdiction other than New York, I request that the laws and authorities of that jurisdiction give this document the fullest effect permissible under their applicable laws and regulations.
XII. DECLARANT'S SIGNATURE AND EXECUTION
I, Jonathan Robert Caldwell, have read this Living Will and Advance Directive in its entirety. I understand its contents and their legal significance. I execute this document voluntarily, of my own free will, and with full knowledge of its consequences.
________________________________________
Jonathan Robert Caldwell
Date: April 1, 2023
XIII. WITNESS ATTESTATION
We, the undersigned witnesses, declare and attest as follows:
The foregoing Living Will and Advance Directive was signed by Jonathan Robert Caldwell (the "Declarant") in our presence on April 1, 2023. We observed the Declarant sign this document. At the time of signing, the Declarant appeared to us to be of sound mind, fully aware of the nature and contents of this document, and under no duress, coercion, or undue influence of any kind.
We further declare that neither of us is the Declarant's designated health care agent or successor health care agent under the Declarant's Health Care Proxy, and that neither of us is a beneficiary, whether named or contingent, under the Declarant's Last Will and Testament or any trust established by the Declarant. Neither of us is related to the Declarant by blood, marriage, or adoption. Neither of us has any claim against the Declarant's estate.
We sign this attestation voluntarily, and we each declare under penalty of perjury that the foregoing statements are true and correct.
Witness 1:
________________________________________
Monica Reyes Lead Associate, Calderwood & Harkness LLP 375 Park Avenue, 42nd Floor New York, New York 10152
Date: April 1, 2023
Witness 2:
________________________________________
Elliot Nguyen Working Associate, Calderwood & Harkness LLP 375 Park Avenue, 42nd Floor New York, New York 10152
Date: April 1, 2023
XIV. NOTARY ACKNOWLEDGMENT
(Optional but Recommended)
STATE OF NEW YORK COUNTY OF NEW YORK
On this 1st day of April, 2023, before me, the undersigned Notary Public, personally appeared Jonathan Robert Caldwell, known to me (or proved to me on the basis of satisfactory evidence) to be the person whose name is subscribed to the within instrument, and acknowledged to me that he executed the same in his authorized capacity, and that by his signature on the instrument, the person, or the entity upon behalf of which the person acted, executed the instrument.
I certify under PENALTY OF PERJURY under the laws of the State of New York that the foregoing paragraph is true and correct.
WITNESS my hand and official seal.
________________________________________
Notary Public, State of New York
Printed Name: ________
Commission Number: ________
My Commission Expires: ________
[NOTARIAL SEAL]
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