(755 ILCS 35/3)
(from Ch. 110 1/2, par. 703)
Execution of a Document.
(a) An individual of sound mind and
having reached the age of majority or having obtained the status of an
emancipated person pursuant to the Emancipation of Minors
Act, as now or hereafter amended, may execute a document directing that if
he is suffering from a terminal condition, then death delaying procedures shall
not be utilized for the prolongation of his life.
(b) The declaration must be signed by the declarant, or another at the
declarant's direction, and witnessed by 2 individuals 18 years of age or
(c) The declaration of a qualified patient diagnosed as pregnant by the
attending physician shall be given no force and effect
as long as in the opinion of the attending physician it is possible that
the fetus could develop to the point of live birth with the continued
application of death delaying procedures.
(d) If the patient is able, it shall be the responsibility of the
patient to provide for notification
to his or her attending physician of the existence of a
declaration, to provide the declaration to the physician and to ask the
attending physician whether he or she is willing to comply with its provisions.
An attending physician who is so notified shall make the declaration, or
copy of the declaration, a part of the patient's
medical records. If the physician is at any time unwilling to comply
with its provisions, the physician shall promptly so advise the declarant.
If the physician is unwilling to comply with its provisions and the patient
is able, it is the patient's responsibility to initiate the transfer to
another physician of the patient's choosing. If the physician is unwilling
to comply with its provisions and the patient is at any time not able to
initiate the transfer, then the attending physician
shall without delay notify the person with the highest priority, as set
forth in this subsection, who is available, able, and willing to make
arrangements for the transfer of the patient and the appropriate medical
records to another physician for the effectuation of the patient's
declaration. The order of priority is as follows: (1) any person authorized
by the patient to make such arrangements, (2) a guardian of the person of
the patient, without the necessity of obtaining a court order to do so, and
(3) any member of the patient's family.
(e) The declaration may, but need not, be in the following form, and
in addition may include other specific directions. Should any specific
direction be determined to be invalid, such invalidity shall not affect
other directions of the declaration which can be given effect without the
invalid direction, and to this end the directions in the declaration are
This declaration is made this ............. day of ............. (month,
year). I, .................., being of sound mind, willfully and
voluntarily make known my desires that my moment of death shall not be
If at any time I should have an incurable and irreversible injury,
disease, or illness judged to be a terminal condition by my attending
physician who has personally examined me and has determined that my death
is imminent except for death delaying procedures, I direct that such
procedures which would only prolong the dying process be withheld or
withdrawn, and that I be permitted to die naturally with only the
administration of medication, sustenance, or the performance of any medical
procedure deemed necessary by my attending physician to provide me with comfort care.
In the absence of my ability to give directions regarding the use of such
death delaying procedures, it is my intention that this declaration shall
be honored by my family and physician as the final expression of my legal
right to refuse medical or surgical treatment and accept the consequences
from such refusal.
City, County and State of Residence .........................
The declarant is personally known to me and I believe him or her to
be of sound mind. I saw the declarant sign the declaration in my presence
(or the declarant acknowledged in my presence that he or she had signed
the declaration) and I signed the declaration as a witness in the presence
of the declarant. I did not sign the declarant's signature above for or at
the direction of the declarant. At the date of this instrument, I am
not entitled to any portion of the estate of the declarant according
to the laws of intestate succession or, to the best of my knowledge and
belief, under any will of declarant or other instrument taking effect at
declarant's death, or directly financially responsible for declarant's medical care.
(Source: P.A. 95-331, eff. 8-21-07.)