Office of the Revisor of Statutes
Minnesota Session Laws - 1995, Regular Session
Key: (1) language to be deleted (2) new language
CHAPTER 211-H.F.No. 1450
An act relating to health; organ donations; amending
the living will form to include provisions for organ
donations; allowing a durable power of attorney for
health care to include provisions for organ donations;
amending Minnesota Statutes 1994, sections 145B.04;
and 145C.05, subdivision 2.
BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF MINNESOTA:
Section 1. Minnesota Statutes 1994, section 145B.04, is
amended to read:
145B.04 [SUGGESTED FORM.]
A living will 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 Living Will
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 living will 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 living will at any time.
(1) The following are my feelings and wishes regarding my
health care (you may state the circumstances under which this
living will 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.
(9) Organ Donation After Death. (If you wish, you may
indicate whether you want to be an organ donor upon your
death.) Initial the statement which expresses your wish:
..... In the event of my death, I would like to donate my
organs. I understand that to become an organ donor, I must be
declared brain dead. My organ function may be maintained
artificially on a breathing machine, (i.e., artificial
ventilation), so that my organs can be removed.
Limitations or special wishes: (If any) ..................
.................................................................
.................................................................
I understand that, upon my death, my next of kin may be
asked permission for donation. Therefore, it is in my best
interests to inform my next of kin about my decision ahead of
time and ask them to honor my request.
I (have) (have not) agreed in another document or on
another form to donate some or all of my organs when I die.
..... I do not wish to become an organ donor upon my death.
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 living
will in my presence and that the declarant is personally known
to me. I am not named as a proxy by the living will, 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. Minnesota Statutes 1994, section 145C.05,
subdivision 2, is amended to read:
Subd. 2. [ADDITIONAL PROVISIONS.] The durable power of
attorney for health care may include additional provisions
consistent with this chapter, including:
(1) the designation of one or more alternative agents to
act if the named agent is unable, unavailable, or unwilling to
serve;
(2) specific instructions to the agent or any alternative
agents;
(3) limitations, if any, on the right of the agent or any
alternative agents to receive, review, obtain copies of, and
consent to the disclosure of the principal's medical
records; and
(4) limitations, if any, on the nomination of the agent as
guardian or conservator for purposes of section 525.544; and
(5) a document of gift for the purpose of making an
anatomical gift, as set forth in sections 525.921 to 525.9224,
or an amendment to, revocation of, or refusal to make an
anatomical gift.
Sec. 3. [APPLICATION; EFFECT.]
Section 1 does not affect the validity of a living will
that does not contain the provisions of section 1. Nothing in
this act affects or overrides the provisions of the uniform
anatomical gift act in Minnesota Statutes, sections 525.921 to
525.9224.
Presented to the governor May 22, 1995
Signed by the governor May 24, 1995, 10:10 a.m.
Official Publication of the State of Minnesota
Revisor of Statutes