Everyone has the right to make decisions about their health care now and in the future. An advance directive is a written statement that dictates your wishes on medical decisions that may be needed in the future should you not be able to make them for yourself. Federal law requires that anyone admitted to a nursing home or other health care facility be given information about their right to make an advance directive upon admission.
Illinois law allows for four types of advance directives, although you are not limited to making only one. Whichever type of advance directive you do decide on, it is important to discuss your wishes with your family, lawyer, and health care providers, as well as provide copies of the directives to each.
Four Types of Advance Directives
Living Will
A living will informs your health care professional if you want death-delaying procedures used if you are terminal or cannot state your wishes verbally. The living will only applies if you have a terminal condition, meaning your condition is irreversible, incurable, and death is imminent.
You may use a standard living will form or create your own and should contain specific directions on the death-delaying procedures you do or do not wish to have. There must be two witnesses of your signature on the living will, but may not include a health care professional.
A living will can be cancelled at any time, either in writing or verbally. If you appoint a health care power of attorney along with your living will, the person you appointed will make health care decisions for you.
Health Care Power of Attorney
A health care power of attorney is someone who you deem responsible for your health care decisions for you when you are unable to make them for yourself. As long as you are able to make those decisions for yourself, you may continue to do so. Your health care power of attorney cannot be a medical professional and they cannot be the witness of your signature when you sign the directive.
The person who is your chosen health care power of attorney should be informed of specific instructions regarding the care you do or do not want. These instructions should include:
- What level of life-sustaining treatments you want;
- When to end life-sustaining treatments;
- What type of treatments you would not want based on moral or religious beliefs;
- If you are an organ donor;
- What your wishes are for your remains.
The health care power of attorney will continue until the time of your death unless otherwise stated and can be cancelled at any time either verbally or in writing. If you wish to change the appointed person who is your health care power of attorney, it must be done in writing. You may also name a second person to act as a back up in the event the first person will not or cannot make these decisions.
Do-Not-Resuscitate/Practitioner Orders for Life-Sustaining Treatment (DNR/POLST Order)
A DNR/POLST Order states that CPR is not to be used if breathing or the heart rate stops and can be used for your desires on life-sustaining treatments. For a DNR/POLST Order to be recognized, it must be signed by you or your authorized legal representative, such as your health care power of attorney, as well as your physician and a witness.
The Illinois Department of Public Health has standard forms available through their website or you can work with your health care provider to prepare a DNR/POLST Order.
Mental Health Treatment Preference Declaration
The mental health treatment preference declaration states your wishes regarding Electroconvulsive Therapy (ECT), psychotropic medications, and admission to a mental health facility for up to 17 days of treatment. The appointed representative you choose will make mental health decisions for you and they must follow your wishes unless a court orders differently or your health or life is in some way threatened.
The mental health preference declaration expires three years from the date you sign it and you must have two witnesses to your signature. You may not have the following witness your signature:
- Family member related by blood, marriage, or adoption
- A health care provider
- An employee of the facility you reside in
Your mental health treatment preference declaration can be canceled at any time provided you are not in current mental health treatment. If you are currently receiving mental health treatment, the declaration may not be cancelled and will not expire until you have successfully completed treatments.
What if You Do Not Have Advance Directives?
It is important that advance directives are in place to ensure your wishes are followed and delays do not occur. If you do not have advance directives in place, under Illinois law two physicians must certify that you are unable to make health care decisions for yourself. You will then be appointed a health care “surrogate” to make certain health care decisions for you. The appointed health care surrogate can be one of the following, in this order:
- Guardian of the patient
- Spouse
- An adult child/children
- A parent
- An adult sibling
- An adult grandchild/grandchildren
- A friend
- Guardian of the estate
The appointed health care surrogate can make many health-related decisions for you, but they cannot tell your physician to withhold life-sustaining measures unless you have a qualifying condition. Two physicians must then certify that your condition fits within one of the qualifying conditions. Qualifying conditions include:
- The condition must be terminal
- The patient is in permanent unconsciousness
- The condition is irreversible or incurable
The surrogate who is appointed to your case is not able to consent to ECT therapy, psychotropic medications, or admission to mental health facility unless they are court-appointed as a guardian or they petition the court to have these things occur.
It is important that you discuss your health care wishes with your family, health care professional, and/or attorney to ensure your wishes are followed. If you decide to change your wishes at any time, it is imperative that you inform those who care for you that you have made changes and what they are.
Advance directives are not required by law and no health care professional can require you to prepare them as a stipulation of treatment and if they object to the decisions in your directives, they are required to continue your treatment until you are transferred to a facility that will respect your wishes.
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