Free Minnesota Health Care Directive Form

A Minnesota health care directive is a legal document that dictates your wishes for medical care. It often provides health care instructions to direct health care providers (MN Stat § 145C.02). Another key element of this document is a health care power of attorney. The principal uses a health care POA to appoint an agent to make decisions on their behalf when they can’t.

Per MN Stat § 145C.03, a health care directive (or an advance directive) in Minnesota is legally valid if it meets the following conditions:

• It’s in writing.
• It’s dated.
• It states the principal’s name.
• It’s executed by a principal with the capacity to do so.
• It has the principal’s signature or the signature of another person authorized to sign on their behalf.
• The principal’s signature is verified by a notary public or two witnesses.
• It consists of health care instructions, a health care power of attorney, or both.

Your MN health care directive will go into effect when your attending physician, advanced practice registered nurse, or physician assistant determines you lack decision-making power (MN Stat § 145C.06). You may use the statutory form (outlined in MN Stat § 145C.16), but you can also use a form that’s similar. An MN advance directive may not condone mercy killing or euthanasia (MN Stat § 145C.14).

Explore the two main parts of a Minnesota health care directive below:

1. Durable Health Care Power of Attorney

A durable health care power of attorney (MN Stat § 145C.1 (Subd. 3)) lets you appoint a trusted agent to make health care decisions on your behalf. They have a duty to act in good faith with the information they have available (MN Stat § 145C.07 (Subd. 3)).

As the principal, you can decide what powers your agent has. Here are some examples of powers you can grant or restrict:

• Consenting, refusing, or withdrawing care or treatment
• Reviewing or releasing your health records
• Choosing your health care providers
• Choosing where you receive care
• Deciding whether to attempt to continue your pregnancy to delivery (if applicable)

Under MN Stat § 145C.3, a person generally cannot serve as your health care agent if they are one of the following individuals:

• The health care provider treating you when you sign the directive or when decisions must be made.
• An employee of your treating health care provider.

However, these individuals may serve as your health care agent if they are related to you by marriage, blood, adoption, or registered domestic partnership, or if you specifically allow it in your directive.

2. Living Will

Your Minnesota living will outlines directions for your attending physician or other health care provider to follow. It allows you to describe the following items to help guide your agent and health care provider when making decisions regarding end-of-life care:

• Your goals for your health care
• Your fears about your health care
• Your spiritual or religious beliefs and traditions
• Your beliefs about when life would be no longer worth living
• Your thoughts about how your medical condition might affect your family

You can also dictate what specific treatments you do and don’t want if you’re temporarily unable to speak for yourself, dying, permanently unconscious, or completely dependent on others for care and unable to make decisions. You may opt in or opt out of artificial breathing, artificial feeding or fluids, attempts to start a stopped heart, blood transfusions, and other treatments.

Your MN living will can also specify your preferences for the following:

• Who you want your attending physician, advanced practice registered nurse, or physician assistant to be
• Where you would want to receive health care
• Where you would like to die
• What your wishes about dying are
• What body parts you’d like to donate and for what cause
• What you want to happen to your body when you die (e.g., burial or cremation)