Clinical Ethics

Advance Directives

You have the right to tell your family, doctors, and nurses what level and kinds of care you want (or don’t want) if in the future you become unable to make these decisions for yourself, or you are not able to communicate. The forms that state your preferences are called “advance directives.”

If you have a written advance directive, make sure your loved ones and your physician know about it and where it is. Bring it when you are admitted to Memorial or any other hospital. A copy can be placed in your medical record so your doctors and nurses see it.

You may choose to express your wishes through advance directives such as:

  • Durable power of attorney for health care
  • Living will
  • health treatment declaration

These documents state your choices about your future care and, if you choose, name someone to decide for you if you should become unable to speak for yourself.

The following forms are available for download. You will need Adobe Acrobat Reader installed in order to read the downloaded file. If you would like additional information about advance directives, call Pastoral Care at 217-788-3585 or the Clinical Ethics Center at 217-757-2353.

Advance Directive Forms

Memorial's Advance Directives  includes frequently asked questions, a Durable Power of Attorney for Health Care and a Living Will.

Memorial's Mental Health Treatment Declaration includes frequently asked questions.

Advance Directive Forms:     English     Spanish

Mental Health Treatment Declaration:     English     Spanish

Physician Orders for Life Sustaining Treatment (POLST):     English     Spanish

Illinois Department of Public Health Uniform Do-Not-Resuscitate (DNR) Advance Directive Order Form:     English      Spanish

DNR Instructions:     English     Spanish