New Jersey Health Care Proxy: Who You Can Appoint and How

If you become incapacitated without naming a healthcare representative, New Jersey does not let your closest friend or unmarried partner make medical decisions for you. The state's default surrogate hierarchy starts with a court-appointed guardian, then a spouse, then a domestic partner, then adult children — and if multiple children disagree, the hospital's ethics committee gets involved, followed by the Superior Court.

That is why a healthcare proxy — formally called a "Proxy Directive" in New Jersey — is not optional.

What a Healthcare Representative Can Do

Under N.J.S.A. 26:2H-53, your designated healthcare representative has broad authority:

• Accept or refuse any treatment, service, or diagnostic procedure — including life-sustaining measures
• Review your medical records
• Make decisions in any healthcare setting: hospitals, nursing homes, assisted living, or at home
• Authorize or decline organ donation, autopsy, and disposition of remains (to the extent permitted by your directive)

This authority activates only when a physician determines you lack decision-making capacity. Until then, you make your own decisions.

Who Cannot Serve as Your Healthcare Representative

New Jersey imposes strict restrictions to prevent conflicts of interest:

• Facility employees: An operator, administrator, or employee of the healthcare institution treating you cannot serve as your representative — unless they are related to you by blood, marriage, domestic partnership, or adoption
• Dual-role physicians: A physician may be appointed as your proxy, but they cannot simultaneously serve as both your attending physician and your healthcare representative

There is no restriction against appointing a friend, neighbor, adult child, sibling, or any other trusted person — as long as they are not disqualified by the facility-employee rule.

Name a Primary and at Least One Alternate

Joint healthcare representatives are not recommended and cannot be authorized to act concurrently under New Jersey law. Instead, designate one primary representative and list one or more alternates in priority order. If your primary representative is unavailable, unable, or unwilling to serve, authority passes to the first available alternate.

The Default Surrogate Hierarchy (What Happens Without a Proxy)

Without a proxy directive and no court-appointed guardian, New Jersey applies this hierarchy under N.J.S.A. 26:14-5:

1. Spouse or civil union partner (not legally separated)
2. Registered domestic partner
3. Adult son or daughter (18+)
4. Custodial parent
5. Adult brother or sister
6. Adult grandchild
7. Closest available adult relative by degree of kinship
8. Close friend demonstrating special care and concern

The critical problem: if multiple people share the same priority tier (such as three adult children), they must reach consensus. Any active dissent blocks treatment consent entirely. The hospital cannot proceed until the dispute is resolved — potentially through an expensive, time-consuming guardianship proceeding in the Superior Court Chancery Division.

For unmarried partners who are not registered as domestic partners, the hierarchy is devastating. An unmarried partner of 20 years has no legal standing unless named in a proxy directive. The estranged adult children or siblings of your partner could override your knowledge of their wishes.

Medical Power of Attorney vs. Health Care Proxy in NJ

"Medical power of attorney" is not the official term in New Jersey, though it is commonly used. New Jersey law uses "Proxy Directive" for the document that designates a healthcare representative, and "Instruction Directive" for a living will. An "Advance Directive" is the umbrella term that typically combines both.

If you have a general durable power of attorney that covers financial matters, it does not grant authority over medical decisions. You need a separate proxy directive for healthcare.

Also critical: a power of attorney and a healthcare proxy both terminate immediately upon death. Neither grants authority to control funeral arrangements — that requires a separate Funeral Agent appointment under N.J.S.A. 45:27-22.

How to Execute Your Proxy Directive

The signing requirements are the same as for any New Jersey advance directive: your proxy directive must be written, dated, and signed by you, then either witnessed by two qualifying adults or notarized. See the witness disqualification rules in our advance directive form guide for details on who can and cannot witness.

The New Jersey Advance Directive & Living Will Kit includes a witness eligibility checklist, a combined proxy and instruction directive template, and coordination guidance for POLST and DNR — so your healthcare representative knows exactly how each document interacts during a medical crisis.

See more New Jersey guides →