Advance Care Planning

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Instructions for a Life Well-Lived

We may not be able to see into the future, but we can plan for it. When you use Advance Care Planning to document your healthcare wishes and needs, you stay in the driver’s seat for your own healthcare, no matter what happens. We provide the roadmap – you do the steering.

Paper documents illustration

North Memorial Health Advantage

  • North Memorial Health has team members who are trained to help customers with Advance Care Planning. They can also help you write a legal document called a Health Care Directive – also known as advance directive or living will – which contains your goals and wishes for your healthcare and allows you to name someone as your advocate, called a Health Care Agent, who will speak for you if you are unable to speak for yourself. Usually people name someone they trust or someone they know well, and someone who would be comfortable being your spokesperson or advocate.
  • You can schedule an appointment with one of our 90 specially trained advance care planning facilitators who will meet with you in either of our two hospitals, our primary care clinics, the North Memorial Health Cancer Center, or any of our North Memorial Health Heart & Vascular locations.
  • There are also opportunities to attend classes on Advance Care Planning, where you can learn more about having these conversation with the people you trust and your healthcare team, as well as learn how to complete advance care planning documents.
  • We have a system-wide process which makes it easy to access information and get help with completing important documents.
  • Advance care planning and finishing health care directives are associated with easing the burden on family members and people you trust to make decisions for your care if you are unable.
  • Advance care planning is also found to improve customer/provider communication and therefore can increase your satisfaction of your healthcare experience – we can all do better when everyone understands your wishes for the future.

Why is Advance Care Planning Important?

When an individual communicates their future healthcare preferences/wishes:

  • There is a higher likelihood that you will be given medical care that matches your values as well as the values.
  • There is reduced stress for family members, and people you love and trust if difficult decisions regarding life-sustaining care must be made.

When Should Individuals Begin Advance Care Planning?

It is recommended that all people over the age of 18 start advance care planning. The best way to start is by having conversations with the people you trust, and your healthcare team. It is important to keep having these conversations, and, Honoring Choices Minnesota® recommends you follow the guide of “5 Ds” as a reminder of when to have advance care planning conversations:

Advance care planning discussions are important when you start a new Decade of life.

When you experience a family change or Divorce, make sure your healthcare directive is updated, or that other people you love and trust know your healthcare values and wishes.

When you’re Diagnosed with a serious health condition, advance care planning is important – start with your healthcare team and update your healthcare agents and people you trust about your new diagnosis.

Whenever you experience the Death of a loved one, your health care directive may need updating. You may change how you feel about life-prolonging treatments or have a different idea of what you would want for your own death.

When you experience a physical Decline because of an existing health condition it might be important to review your health care directive or make changes to your future health care wishes based on your health changes.

Call the North Memorial Health Advance Care Planning Hotline: 763-581-8282 or email for help.

Advance Care Planning Process

1. Understand Your Own Wishes
Advance care planning is about making your preferences known to family, loved ones and providers. Before you can share your preferences, you must understand the options and determine what your preferences really are. There are many places to learn more about how to plan for your care. Some important questions to consider include:

  • Are there any situations in which I would want to refuse or stop treatment(s)?
  • Are there therapies I would want or not want?
  • Who do I want making decisions for me in the event that I am unable to make decisions for myself?

2. Choose a Health Care Agent
A health care agent should be someone you trust to speak on your behalf if you are not able to talk or communicate with your healthcare team. An agent does not make decisions based upon their own opinion, but rather based on the values and goals that have been communicated to them by the people they represent.

3. Complete Your Health Care Directive
There are several kinds of documents used in advance care planning. Each document informs heath care providers about your specific wishes. The documents may vary by state, but they must be signed and may need to be witnessed or notarized in order to be considered legal documents. A legal document, called a health care directive, belongs to you, includes your wishes and can only be cancelled or changed when you choose. Hopefully your health care directive names a health care agent – legally, they have to do their best to follow the wishes you have written in your legal health care directive.

What is a Health Care Agent?

Sometimes people think of health care agents as advocates or see them as a healthcare decision maker spokesperson, because their job is to talk with your healthcare team when you are unable. The name of this role varies by state. Some states call this role a Durable Medical Power of Attorney or Durable Power of Attorney for Healthcare, or use the term POA. Sometimes a health care agent may be called a proxy, surrogate, advocate, representative or decision maker. No matter what they are called, your health care agent, as they are called in Minnesota, is an official duty that is identified by a legal document, which in Minnesota is called a Health Care Directive.

What types of decisions might my healthcare agent need to make?

  • Medical care or services, such as tests, medications and surgery
  • Stopping treatments, even those treatments that might prolong your life
  • Reviewing and releasing your medical records
  • Choosing providers or organizations to provide your care
  • Move you to another location for care

Making medical decisions for someone else is a big responsibility – you will want to let your health care agent know that you have named them in a legal document. You can discuss with your health care agent your specific wishes, and your wishes for your future, as well as your end-of-live.


Julie Borchert, MSW, LICSW
Social Worker

Adina Stokes, LSW
Advance Care Planning Social Worker

If you have other questions, please call the ACP Hotline: 763-581-8282

Frequently Asked Questions

What is a health care directive?

A health care directive is a written document that informs others of your wishes about your health care. It also allows you to name a person to act as your health care agent and make decisions about your health for you if you are not able to do so yourself. You must be at least 18 years old to make a health care directive or to be an agent.

Why should I have a health care directive?

A health care directive is important in case you are ever unable to make your own health care choices. It tells your doctor and your loved ones what your care wishes are and who you have chosen to make decisions on your behalf.

What can I put in a health care directive?

You may be as specific or general as you wish. You decide what information to include in your health care directive. It is important to discuss the information in your health care directive with your health care agent(s) and loved ones. Your health care directive may include many types of information, including:
- The name of someone you trust to be your primary health care agent and make health care decisions for you if you are not able to make them for yourself
- The name of an alternate health care agent in case your primary agent is not available
- Your goals, values and wishes about your health care
- The types of medical treatment you want or do not want
- Where you want to receive care
- Instructions about CPR (Cardio Pulmonary Resuscitation) and breathing support
- Instructions about artificial nutrition and hydration
- Instructions if you are pregnant
- A statement about the donation of organs, tissues and eyes
- Your funeral arrangements

Are there any limits to what I can put in my health care directive?

There are some limits about what you can put in your health care directive.
- Your health care agent must be at least 18 years old
- Your agent cannot be your health care provider, unless the provider is a family member or you give reasons for the naming of this agent in your directive
- You cannot request assisted suicide or euthanasia

Where can I get a blank health care directive?

North Memorial Health uses the Honoring Choices Health Care Directive form. This form may be downloaded on this page. You may also use an alternate health care directive form of your choosing as long as it meets the legal requirements for the state of Minnesota.

What makes a health care directive legal?

In order to be a legal document in the state of Minnesota, your health care directive must:
- Be in writing
- State your full name
- Include the date it was written
- Be signed by you or someone you authorize to sign for you when you are able to clearly understand and communicate your health care wishes
- Be notarized by a notary public or signed by two witnesses, neither of whom are named as your health care agent
- Name a person or persons to be your health care agent(s) and make health care decisions for you if you cannot, and/or provide information about your health care

What should I do with my health care directive after I have signed it?

You should give copies of your directive to your physician or other health care provider, your agent(s) and also close family or loved ones. It is important to review and update your directive as your health needs change. Keep the original in a safe place where you can easily find it.

I prepared my directive in another state. Is it still good?

Health care directives prepared in other states are legal if they meet the requirements of the state of Minnesota.

How long does a health care directive last? Can I change or cancel it?

Your health care directive lasts until you change or cancel it. You may cancel your directive by:
- Writing a new health care directive
- Drafting a written statement saying you want to cancel it
- Destroying all copies of it
- Telling at least two people that you want to cancel it

What happens if I do not have a health care directive?

You will still receive health care services if you do not have a health care directive. Your health care providers will do their best to listen to your loved ones so that the care you get fits with your wishes. Having a health care directive is the best way to ensure that you receive the care you desire.

Get Started

Complete the correct form below to begin creating your advance care plan. Forms are available in multiple languages for your convenience.

Honoring Choices Healthcare Directive – English
Honoring Choices Healthcare Directive – Hmong
Honoring Choices Healthcare Directive – Russian
Honoring Choices Healthcare Directive – Somali
Honoring Choices Healthcare Directive – Spanish


For more information about Advance Care Planning assistance and resources, call us at 763-581-8282.