MINNESOTA HEALTH CARE DIRECTIVE
(Living Will & Durable Power of Attorney for Health Care)
[// GUIDANCE: This template combines a “living will” (treatment instructions) with a “durable power of attorney for health care” (health-care agent appointment) in the single “Health Care Directive” format authorized under Minn. Stat. § 145C.01 et seq. Customize bracketed terms, delete inapplicable options, and provide copies to all relevant providers and decision-makers.]
TABLE OF CONTENTS
- Document Header
- Definitions
- Operative Provisions
- Representations & Warranties
- Covenants & Restrictions
- Default & Remedies
- Risk Allocation
- Dispute Resolution
- General Provisions
- Execution Block
1. DOCUMENT HEADER
1.1 Title. Minnesota Health Care Directive (“Directive”).
1.2 Parties.
(a) “Principal”: [FULL LEGAL NAME], date of birth [DOB], residing at [ADDRESS].
(b) “Health-Care Agent” (“Agent”): [AGENT NAME], residing at [ADDRESS].
(c) “Alternate Agent(s)” (optional): [ALT AGENT 1]; [ALT AGENT 2].
1.3 Effective Date. This Directive becomes effective on the later of (i) the date signed below or (ii) the date the Principal lacks capacity to make or communicate health-care decisions, unless stated otherwise herein.
1.4 Governing Law. This Directive is created pursuant to, and shall be construed in accordance with, Minnesota Statutes chapter 145C and other applicable state health-care law (“State Health-Care Law”).
2. DEFINITIONS
For purposes of this Directive (alphabetical):
“Agent” means the individual appointed in Section 3.1 to make health-care decisions on the Principal’s behalf.
“Decisional Incapacity” means the condition in which the Principal lacks the understanding or ability to communicate informed health-care decisions, as determined by the attending physician or advanced practice registered nurse.
“Directive” means this Minnesota Health Care Directive, together with any valid amendments or restatements.
“Good Faith” means honesty in fact in the conduct of the transaction concerned and the observance of reasonable health-care standards of practice.
“Health-Care Decision” has the meaning given in Minn. Stat. § 145C.01, subd. 5.
“Health-Care Provider” means any person or facility licensed, certified, or otherwise authorized by law to provide health-care services.
“Principal” means the individual executing this Directive.
3. OPERATIVE PROVISIONS
3.1 Appointment of Agent. The Principal hereby appoints the Agent to make any and all Health-Care Decisions during periods of Decisional Incapacity, subject to the limitations and instructions herein.
3.2 Alternate Agent(s). If the Agent is unable, unwilling, or not reasonably available to act, decision-making authority shall pass in the order listed in Section 1.2(c).
3.3 Scope of Authority. Except as limited below, the Agent shall have the full authority a legally competent Principal would possess, including but not limited to:
(a) Consent, refuse, or withdraw consent to any care, treatment, service, or procedure;
(b) Access medical records and receive protected health information under 45 C.F.R. § 164.502;
(c) Apply for governmental or private benefits to defray costs of care;
(d) Decide about admission to or discharge from health-care facilities, including nursing homes and hospice;
(e) Autopsy, anatomical gifts, and final disposition decisions as allowed by law.
3.4 Treatment Instructions.
(a) Life-Prolonging Treatment. If I am in a terminal condition or persistent vegetative state, my preference is: [SELECT ONE: receive all available life-prolonging treatment / withhold or withdraw life-prolonging treatment / other instructions: ______].
(b) Artificial Nutrition & Hydration: [SELECT ONE or provide details].
(c) Pain Management: I desire adequate pain relief even if it may hasten death, subject to applicable law.
3.5 End-of-Life & Do-Not-Resuscitate (DNR). [INCLUDE specific DNR or POLST references if completed].
3.6 Pregnancy Clause (if applicable). If I am pregnant at the time decisions must be made, my wishes are: [Insert instructions consistent with Minn. Stat. § 145C.14].
3.7 Mental Health Treatment Instructions (optional). [Insert any special instructions or limitations regarding electroconvulsive therapy, psychotropic medications, facility admission, etc.]
3.8 Anatomical Gifts. I hereby [donate / decline to donate] any needed organs or tissues for transplant, therapy, or research, subject to the Uniform Anatomical Gift Act.
3.9 Additional Instructions. [Insert personal, religious, or cultural directives].
4. REPRESENTATIONS & WARRANTIES
4.1 Capacity. The Principal affirms being at least 18 years of age and having decision-making capacity at execution.
4.2 Voluntariness. Execution of this Directive is voluntary and not the result of fraud, duress, or undue influence.
4.3 Consistency with Law. This Directive complies with Minn. Stat. § 145C.03 (execution requirements) and may be relied upon in Good Faith by Health-Care Providers.
4.4 Disclosure. The Principal has provided the Agent with all material information necessary to fulfill fiduciary duties hereunder.
5. COVENANTS & RESTRICTIONS
5.1 Fiduciary Standard. The Agent shall act in Good Faith, consistent with the Principal’s expressed wishes and best interests, and in accordance with Minn. Stat. § 145C.05.
5.2 Consultations. The Agent shall consult, where feasible, with interested family members and health-care professionals before making significant decisions.
5.3 Recordkeeping. Upon request, the Agent shall provide an accounting of decisions and actions taken under this Directive.
5.4 Conflict-of-Interest. The Agent shall promptly disclose and, where possible, avoid any personal interests that may materially conflict with the Principal’s interests.
6. DEFAULT & REMEDIES
6.1 Agent Default Events. The following constitute “Agent Defaults”:
(a) Failure to act in Good Faith;
(b) Acting outside the scope of granted authority;
(c) Refusal or inability to serve.
6.2 Remedies. Upon any Agent Default, any interested person may petition a court of competent jurisdiction for:
(a) Temporary or permanent removal of the Agent;
(b) Appointment of the next Alternate Agent or a guardian ad litem;
(c) Injunctive relief to prevent irreparable harm.
6.3 Emergency Provider Authority. Nothing herein limits a Health-Care Provider’s statutory authority to provide emergency treatment when delay would endanger life or health.
7. RISK ALLOCATION
7.1 Indemnification of Providers. The Principal, to the fullest extent permitted by law, releases and agrees to indemnify Health-Care Providers who, in Good Faith, rely on this Directive (“Provider Protection”).
7.2 Limitation of Liability. No Agent or Health-Care Provider acting in Good Faith and in substantial compliance with this Directive shall be liable for civil or criminal damages (the “Good-Faith Standard”).
7.3 Force Majeure. Performance under this Directive may be excused to the extent rendered impossible by war, riot, acts of God, or materially similar events beyond reasonable control.
8. DISPUTE RESOLUTION
8.1 Governing Law. All matters arising under this Directive shall be governed by and interpreted in accordance with State Health-Care Law, without regard to conflict-of-laws rules.
8.2 Injunctive Relief. Courts of competent jurisdiction may issue temporary, preliminary, or permanent injunctive relief to enforce or effectuate Health-Care Decisions herein (“Healthcare Directive-Specific Relief”).
[// GUIDANCE: Forum selection, arbitration, and jury-waiver clauses are generally inappropriate for personal health-care directives and therefore omitted.]
9. GENERAL PROVISIONS
9.1 Amendment & Revocation. The Principal may amend or revoke this Directive at any time by:
(a) A written, dated, and signed revocation;
(b) Physical destruction of the Directive;
(c) An oral statement of intent to revoke, communicated to at least two witnesses; or
(d) Execution of a subsequent directive, all as recognized under Minn. Stat. § 145C.09.
9.2 Copies; Reliance. A photocopy or electronically transmitted copy of this Directive has the same effect as the original.
9.3 Severability. If any provision is determined invalid or unenforceable, the remaining provisions shall remain in full force, and the invalid portion shall be conformed to the minimum required to be valid.
9.4 Entire Agreement. This Directive constitutes the complete expression of the Principal’s health-care instructions and supersedes all prior inconsistent directives.
9.5 Counterparts & Electronic Signatures. This Directive may be executed in multiple counterparts, including counterparts executed via verified electronic signature, each constituting an original.
10. EXECUTION BLOCK
[// GUIDANCE: Minnesota allows EITHER two qualified witnesses OR a notary public. Choose one method only and delete the other to avoid confusion.]
10.1 Principal Signature
I, [PRINCIPAL NAME], sign my name to this Minnesota Health Care Directive on [DATE].
Principal Signature
10.2 OPTION A – WITNESS ATTESTATION
(Use two witnesses, each at least 18 years old, not appointed as Agent or Alternate Agent, not health-care provider currently serving the Principal, and not entitled to inherit from the Principal.)
We declare that the Principal voluntarily signed this Directive in our presence, appears to be of sound mind, and is not under duress or undue influence.
Witness #1
Name: ______
Address: _____
Signature: ___
Date: _________
Witness #2
Name: ______
Address: _____
Signature: ___
Date: _________
10.3 OPTION B – NOTARY PUBLIC ACKNOWLEDGMENT
State of Minnesota )
County of ______ ) ss.
On this ___ day of ____, 20__, before me, a Notary Public in and for said County and State, personally appeared [PRINCIPAL NAME], known to me or satisfactorily proven to be the person whose name is subscribed to the foregoing Minnesota Health Care Directive, and acknowledged that (s)he executed the same freely and voluntarily.
Notary Public
My Commission Expires: ______
[// GUIDANCE:
1. Distribution – Provide copies to the Agent, Alternate Agent(s), primary physician, and any health-care facility likely to treat the Principal.
2. Portability – Minnesota recognizes out-of-state directives if executed under that state’s law; confirm reciprocity when traveling.
3. Updates – Review and, if needed, re-execute every 3–5 years or after major life events (marriage, divorce, diagnosis, etc.) to avoid challenges based on outdated intent. ]