Minnesota Session Laws - 1992, Regular Session

  

                         Laws of Minnesota 1992 

                        CHAPTER 535-S.F.No. 2111 
           An act relating to living wills; adding certain 
          information to the suggested health care declaration 
          form; amending Minnesota Statutes 1990, section 
          145B.04. 
BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF MINNESOTA: 
    Section 1.  Minnesota Statutes 1990, section 145B.04, is 
amended to read: 
    145B.04 [SUGGESTED FORM.] 
    A declaration executed after August 1, 1989, under this 
chapter must be substantially in the form in this section.  
Forms printed for public distribution must be substantially in 
the form in this section. 

                        "Health Care Declaration
Notice: 
    This is an important legal document.  Before signing this 
document, you should know these important facts: 
    (a) This document gives your health care providers or your 
designated proxy the power and guidance to make health care 
decisions according to your wishes when you are in a terminal 
condition and cannot do so.  This document may include what kind 
of treatment you want or do not want and under what 
circumstances you want these decisions to be made.  You may 
state where you want or do not want to receive any treatment. 
    (b) If you name a proxy in this document and that person 
agrees to serve as your proxy, that person has a duty to act 
consistently with your wishes.  If the proxy does not know your 
wishes, the proxy has the duty to act in your best interests.  
If you do not name a proxy, your health care providers have a 
duty to act consistently with your instructions or tell you that 
they are unwilling to do so. 
    (c) This document will remain valid and in effect until and 
unless you amend or revoke it.  Review this document 
periodically to make sure it continues to reflect your 
preferences.  You may amend or revoke the declaration at any 
time by notifying your health care providers. 
    (d) Your named proxy has the same right as you have to 
examine your medical records and to consent to their disclosure 
for purposes related to your health care or insurance unless you 
limit this right in this document. 
    (e) If there is anything in this document that you do not 
understand, you should ask for professional help to have it 
explained to you. 
TO MY FAMILY, DOCTORS, AND ALL THOSE CONCERNED WITH MY CARE: 
    I, .........................., born on ........ 
(birthdate), being an adult of sound mind, willfully and 
voluntarily make this statement as a directive to be followed if 
I am in a terminal condition and become unable to participate in 
decisions regarding my health care.  I understand that my health 
care providers are legally bound to act consistently with my 
wishes, within the limits of reasonable medical practice and 
other applicable law.  I also understand that I have the right 
to make medical and health care decisions for myself as long as 
I am able to do so and to revoke this declaration at any time. 
    (1) The following are my feelings and wishes regarding my 
health care (you may state the circumstances under which this 
declaration applies): 
................................................................ 
................................................................ 
................................................................ 
................................................................ 
    (2) I particularly want to have all appropriate health care 
that will help in the following ways (you may give instructions 
for care you do want): 
.................................................................
.................................................................
.................................................................
.................................................................
    (3) I particularly do not want the following (you may list 
specific treatment you do not want in certain circumstances): 
.................................................................
.................................................................
     (4) I particularly want to have the following kinds of 
life-sustaining treatment if I am diagnosed to have a terminal 
condition (you may list the specific types of life-sustaining 
treatment that you do want if you have a terminal condition): 
............................................................... 
............................................................... 
............................................................... 
............................................................... 
     (5) I particularly do not want the following kinds of 
life-sustaining treatment if I am diagnosed to have a terminal 
condition (you may list the specific types of life-sustaining 
treatment that you do not want if you have a terminal condition):
............................................................... 
............................................................... 
............................................................... 
............................................................... 
     (6) I recognize that if I reject artificially administered 
sustenance, then I may die of dehydration or malnutrition rather 
than from my illness or injury.  The following are my feelings 
and wishes regarding artificially administered sustenance should 
I have a terminal condition (you may indicate whether you wish 
to receive food and fluids given to you in some other way than 
by mouth if you have a terminal condition): 
............................................................... 
............................................................... 
............................................................... 
............................................................... 
     (7) Thoughts I feel are relevant to my instructions.  (You 
may, but need not, give your religious beliefs, philosophy, or 
other personal values that you feel are important.  You may also 
state preferences concerning the location of your care.) 
............................................................... 
............................................................... 
............................................................... 
............................................................... 
     (8) Proxy Designation.  (If you wish, you may name someone 
to see that your wishes are carried out, but you do not have to 
do this.  You may also name a proxy without including specific 
instructions regarding your care.  If you name a proxy, you 
should discuss your wishes with that person.) 
     If I become unable to communicate my instructions, I 
designate the following person(s) to act on my behalf 
consistently with my instructions, if any, as stated in this 
document.  Unless I write instructions that limit my proxy's 
authority, my proxy has full power and authority to make health 
care decisions for me.  If a guardian or conservator of the 
person is to be appointed for me, I nominate my proxy named in 
this document to act as guardian or conservator of my person. 
     Name:  ................................................. 
     Address:  .............................................. 
     Phone Number:  ......................................... 
     Relationship:  (If any) ................................ 
     If the person I have named above refuses or is unable or 
unavailable to act on my behalf, or if I revoke that person's 
authority to act as my proxy, I authorize the following person 
to do so: 
    Name:  .....................................................
    Address:  ..................................................
    Phone Number:  .............................................
    Relationship:  (If any) ....................................
    I understand that I have the right to revoke the 
appointment of the persons named above to act on my behalf at 
any time by communicating that decision to the proxy or my 
health care provider. 
    I (have) (have not) agreed in another document or on 
another form to donate some or all of my organs when I die. 
    DATE:  .....................................................
    SIGNED: ....................................................
    STATE OF .........................  
    ................................... 
    COUNTY OF ........................ 
    Subscribed, sworn to, and acknowledged before me by 
.......... on this ..... day of ............, 19... 
    ......................................... 
    NOTARY PUBLIC 
    OR 
    (Sign and date here in the presence of two adult witnesses, 
neither of whom is entitled to any part of your estate under a 
will or by operation of law, and neither of whom is your proxy.) 
     I certify that the declarant voluntarily signed this 
declaration in my presence and that the declarant is personally 
known to me.  I am not named as a proxy by the declaration, and 
to the best of my knowledge, I am not entitled to any part of 
the estate of the declarant under a will or by operation of law. 
Witness ....................  Address ..................... 
Witness ....................  Address ..................... 
Reminder:  Keep the signed original with your personal papers. 
Give signed copies to your doctors, family, and proxy." 
     Sec. 2.  [APPLICATION.] 
    Section 1 does not affect the validity of a declaration 
that does not contain the provisions of section 1, if the 
declaration is otherwise substantially in the form in Minnesota 
Statutes, section 145B.04. 
    Presented to the governor April 17, 1992 
    Signed by the governor April 24, 1992, 4:10 p.m.