Advanced Directives
Statement of Illinois Law on Advance Directives & DNR Orders
You have the right to make decisions about the health care you receive now and in the future. An advance directive is a written statement you prepare about how you want your medical decisions made in the future, if you are not able to make them for yourself. A do not resuscitate order (DNR order) is a medical treatment order that says cardiopulmonary resuscitation (CPR) will not be used if your heart and/or breathing stops.
Federal law requires you be told of your right to make an advance directive when you are admitted to a health care facility. Illinois law allows for three types of advance directives: (1) Health Care Power of Attorney; (2) Living Will; and (3) Mental Health Treatment Preference Declaration.
In addition, you can ask your physician to help you prepare a DNR order. You may choose to discuss these different types of advance directives and DNR order with your doctor and/or attorney.
You may decide to make more than one advance directive and DNR order after reviewing the information. For example, you could make a health care power of attorney and a living will.
If you have one or more advance directives and/or a DNR order, tell your doctor and other health care providers and provide them with a copy. You may also want to provide a copy to family members, and you should provide a copy to those you appoint to make these decisions for you.
State law provides copies of sample advance directive forms. If you need assistance in formulating or changing an Advanced Directive, we will have someone here to help you. Tell your doctor or nurse if you need assistance with this.
Health Care Power of Attorney
The health care power of attorney lets you choose someone to make health care decisions for you if you are no longer able to make these decisions for yourself. You are called the “principal” in the power of attorney form. The person you choose to make decisions is called your “agent”. Your agent would be able to make health care decisions for you if you were no longer able to make these decisions for yourself. So long as you are able to make these decisions, you will have the power to do so. You may use a standard health care power of attorney form or write your own. You may give you agent specific directions about the health care you do or do not want.
The agent you choose cannot be your doctor or other health care provider. You should have someone who is not your agent witness your signing of the power of attorney.
The power of your agent to make health care decisions on your behalf is broad. Your agent would be required to follow any specific instruction you give regarding care you want provided or withheld. For example, you can say whether you want:
- all life-sustaining treatments provided in all events;
- whether you want all life-sustaining treatment ended;
- instruction regarding refusal of certain types of treatments on religious or other personal grounds; and
- instruction for anatomical gifts and disposal of remains.
Unless you include time limits, the health care power of attorney will continue in effect from the time it is signed until your death. You can cancel your power of attorney at any time, either by telling someone or by canceling it in writing. You can name a backup agent to act if the first one cannot or will not take action. If you want to change your power of attorney, you must do so in writing. By designating someone you trust to act on your behalf, you are able to control decisions concerning your future medical treatment
Living Will
A living will tells your doctor whether you want death-delaying procedures used if you have a terminal condition and are unable to state your wishes. A living will, unlike a health care power of attorney, only applies if you have a terminal condition. A terminal condition means an incurable and irreversible condition such that death is imminent and the application of any death delaying procedures serves only to prolong the dying process. Even if you sign a living will, food and water cannot be withdrawn if it would be the only cause of death. Also, if you are pregnant and doctors think you could have a live birth, your living will cannot go into effect.
You can use a standard living will form or write your own. You may write specific directions about the death-delaying procedures you do or do not want. In certain circumstances, death-delaying procedures might include assisted ventilation, artificial kidney treatments, intravenous feeding or medication, blood transfusions, tube feeding and other procedures that serve only to delay death.
Two people must witness your signing of the living will. Your doctor cannot be a witness. It is your responsibility to tell your doctor if you have a living will if you are able to do so. You can cancel your living will at any time, either by telling someone or be canceling it in writing. If you have both a health care power of attorney and a living will, the agent you name in your power of attorney will make your health-care decisions unless he or she is unavailable.
How does a Power of Attorney for Health Care
differ from
a Living Will?
A Power of Attorney for Health Care is much broader than a Living Will. A Living Will is a short form stating you do not want life-sustaining treatment used if you develop a terminal illness. A Power of Attorney for Health Care, on the other hand, is not limited to situations where you have a terminal illness. It allows you to designate an agent to make health care decisions for you in any situation where you are unable to do so. A Power of Attorney for Health Care also permits you to leave specific directions for your agent to follow when making decisions regarding your health care treatment.
If you do not wish to be kept alive by life sustaining treatment, you should consider signing both a Living Will and a Power of Attorney for Health Care. Most states (including Illinois) have statutes authorizing Living Wills, but many states do not provide for Power of Attorney for Health Care.
Mental Health Treatment Preference Declaration
A mental health treatment preference declaration lets you say if you want to receive electroconvulsive treatment (ECT) or psychotropic medication when you have a mental illness and are unable to make these decisions for yourself. It also allows you to say whether you wish to be admitted to a mental health facility for up to 17 days of treatment.
You can write your wishes and/or choose someone to make your mental health decisions for you. In the declaration, you are called the “principal” and the person you choose is called an “attorney-in-fact.” Neither your doctor nor any employee of a health care facility in which you are a patient or resident may be your attorney-in-fact. Your attorney-in-fact must accept the appointment in writing before he or she can start making decisions regarding your mental health treatment. The attorney-in-fact must make decisions consistent with any desires you express in your declaration unless a court orders differently or an emergency threatens your life or health.
Your mental health treatment preference expires three years from the date you sign it. Two people must witness you signing the declaration. The following people may not witness your signing of the declaration: your doctor; an employee of a health care facility in which you are a patient or resident; or a family member related by blood, marriage or adoption. You may cancel your declaration in writing prior to its expiration as long as you are not receiving mental health treatment at the time of cancellation. If you are receiving mental health treatment, your declaration will not expire and you may not cancel it until the treatment is successfully completed.
Do-Not Resuscitate Order
You may also ask your doctor about a do-not-resuscitate order (DNR order). A DNR order is a medical treatment order stating that cardiopulmonary resuscitation (CPR) will not be attempted if your heart and/or breathing stops. The law authorizing the development of the form specifies that an individual (or his or her authorized legal representative) may execute the IDPH Uniform DNR Advance Directive directing that resuscitation efforts shall not be attempted. Therefore, a DNR order completed on the IDPH Uniform DNR Advance Directive contains an advance directive made by an individual (or legal representative), and also contains a physician’s order that requires a physician’s signature.
Before a DNR order may be entered into your medical record, either you or another person (your legal guardian, health care power of attorney or surrogate decision maker) must consent to the DNR order. This consent must be witnessed by two people who are 18 years or older. If a DNR order is entered into your medical record, appropriate medical treatment other than CPR will be given to you.