Minnesota Has No Next-of-Kin Rule. Without a Health Care Directive, the Answer Is a Guardianship Petition.

Two things about Minnesota’s health care directive statute are not what people assume.

The first is what happens when there is no directive. Most people believe that a spouse, then an adult child, then a parent, automatically has authority to make medical decisions for an incapacitated adult. Many states have a statute that says exactly that. Minnesota’s chapter 145C says the opposite — expressly:

“This chapter does not create a presumption concerning the intention of an individual who has not executed a health care directive and, except as otherwise provided by section 145C.15, does not impair or supersede any right or responsibility of an individual to consent, refuse to consent, or withdraw consent to health care on behalf of another in the absence of a health care directive.”

Minn. Stat. § 145C.10(e). The predecessor chapter, which still governs living wills executed before August 1, 1998, is drafted the same way. Minn. Stat. § 145B.12, subd. 1, provides that where an individual has not executed or has revoked a living will, “a presumption is not created” as to “the individual’s intentions concerning the provision of health care” or “the appropriate health care to be provided.”

The second is that the chapter is asymmetric. It is materially easier, under Minnesota law, to make sure you are kept alive than to make sure you are not. A direction to provide life-sustaining care is backed by an affirmative statutory duty on the provider, including a duty to transfer you by emergency means. A direction to withhold it is backed by qualified immunity — and by a matching immunity for the provider who declines to comply.

Both of those facts are reasons to sign a directive, and reasons to be precise about what it says.

Who decides if I never signed anything?

Not automatically your spouse. Chapter 145C disclaims creating any such rule, and the chapter does not contain a priority list of family members. What Minnesota law supplies instead, in the places I can verify it, is narrower and more procedural:

A guardian, appointed by a court. Under Minn. Stat. § 524.5-313(c)(4)(i), a guardian may be granted “the power to give any necessary consent to enable the person subject to guardianship to receive necessary medical or other professional care, counsel, treatment, or service, except that no guardian may give consent for psychosurgery, electroshock, sterilization, or experimental treatment of any kind unless the procedure is first approved by order of the court as provided in this clause.” The same clause bars a guardian from consenting “to any medical care for the person subject to guardianship which violates the known conscientious, religious, or moral belief of the person subject to guardianship.”

Read the grant carefully. It is a power to consent — to enable the person to receive care. The clause does not on its face speak to refusing or withdrawing life-sustaining treatment, and a guardian operates under § 524.5-313(a) “subject to the control and direction of the court at all times and in all things,” with only “those powers necessary to provide for the demonstrated needs” of the person under § 524.5-313(b).

A designated agency, but only for mental health treatment. Minn. Stat. § 253B.04, subd. 1a(a), provides that if a mental health provider determines a person lacks capacity to give informed consent to treatment or admission, “and in the absence of a health care directive or health care power of attorney that authorizes consent, the designated agency or its designee may give informed consent for mental health treatment or admission to a treatment facility or state-operated treatment program on behalf of the person.” If the designated agency declines, subd. 1b lets the person, or an interested person acting on their behalf, petition the court to appoint a substitute decision maker.

Notice the phrasing: that authority exists “in the absence of a health care directive.” The directive displaces it.

And, for withdrawal of nutrition or hydration, a bar. Minn. Stat. § 145B.12, subd. 2: “Nothing in this chapter shall be construed to authorize or justify the withholding or withdrawal of artificially administered nutrition or hydration from any person who has not issued a living will or designated a proxy under this chapter.”

So the practical answer to “what happens if I do nothing” is not “my family decides.” It is: somebody files a guardianship petition, a court hears it, and a court-supervised guardian with a consent power makes decisions inside limits a judge sets. That is expensive, public, and slow — and it is exactly the outcome a two-page document prevents. Our guide to Minnesota guardianship and conservatorship covers how that petition works and why an existing directive is usually the strongest argument against granting one.

What makes a Minnesota health care directive legally sufficient?

Six requirements, and they are shorter than most people expect. Minn. Stat. § 145C.03, subd. 1, provides that to be legally sufficient a health care directive must:

“(1) be in writing; (2) be dated; (3) state the principal’s name; (4) be executed by a principal with capacity to do so with the signature of the principal or with the signature of another person authorized by the principal to sign on behalf of the principal; (5) contain verification of the principal’s signature or the signature of the person authorized by the principal to sign on behalf of the principal, either by a notary public or by witnesses as provided under this chapter; and (6) include a health care instruction, a health care power of attorney, or both.”

A “principal” is “an individual age 18 or older who has executed a health care directive.” § 145C.01, subd. 8. A “health care agent” is “an individual age 18 or older who is appointed by a principal in a health care power of attorney to make health care decisions on behalf of the principal.” § 145C.01, subd. 2.

On the witness count. Clause (5) says “either by a notary public or by witnesses as provided under this chapter.” It does not state a number. The operative restrictions on who may witness are in § 145C.03, subd. 3: a health care agent or alternate agent “may not act as a witness or notary public for the execution of the health care directive that includes the health care power of attorney,” and “[a]t least one witness to the execution of the health care directive must not be a health care provider providing direct care to the principal or an employee of a health care provider providing direct care to the principal on the date of execution.” A notary, by contrast, “may be an employee of a health care provider providing direct care to the principal.”

The number two comes from the suggested form. Section 145C.05, subd. 1, says a directive “may, but need not, be in the form contained in section 145C.16,” and the § 145C.16 form states: “This document must be signed by me. It also must either be verified by a notary public (Option 1) OR witnessed by two witnesses (Option 2). It must be dated when it is verified or witnessed.” The form’s Option 2 adds: “Two witnesses must sign. Only one of the two witnesses can be a health care provider or an employee of a health care provider giving direct care to me on the day I sign this document.” The form’s witness attestation also has each witness state “I am at least 18 years of age” and “I am not named as a health care agent or an alternate health care agent in this document.”

Practical translation: use the notary, or use two witnesses who are at least 18 and are not the agent — which is what the statutory form contemplates. There is no reason to litigate whether one witness would have sufficed.

Who cannot serve as your agent. Section 145C.03, subd. 2(a), disqualifies anyone the principal appointed under § 145C.05, subd. 2(b), to determine the principal’s decision-making capacity — you cannot make the same person both the gatekeeper and the decision-maker. Paragraph (b) disqualifies a health care provider attending the principal on the date of execution or on the date decisions must be made, and an employee of such a provider — “unless the individual appointed is related to the principal by blood, marriage, registered domestic partnership, or adoption, or unless the principal has otherwise specified in the health care directive.” Section 145C.05, subd. 2(a)(9), is the escape hatch: a directive may state “specific reasons why a principal wants a health care provider or an employee of a health care provider attending the principal to be eligible to act as the principal’s health care agent.”

Is my out-of-state directive good in Minnesota?

Usually yes, and the standard is generous. Minn. Stat. § 145C.04(a): a health care directive “or similar document executed in another state or jurisdiction is legally sufficient under this chapter if it: (1) complies with the law of the state or jurisdiction in which it was executed; or (2) complies with section 145C.03.” Either one. Paragraph (b) adds the one limit that runs through the whole chapter: nothing in the section authorizes a document “to override the provisions of section 609.215 prohibiting assisted suicide.”

That said, “legally sufficient” is a legal conclusion, not a bedside outcome. A Minnesota hospital confronted with an unfamiliar out-of-state form at 2 a.m. will move faster with a Minnesota-form directive in hand. If you have relocated, re-execute.

When does a directive actually take effect?

The default trigger is a clinical determination of incapacity — not a diagnosis, not a court finding. Section 145C.02 provides that a directive “may include a health care power of attorney to appoint a health care agent to make health care decisions for the principal when the principal, in the judgment of the principal’s attending physician, advanced practice registered nurse, or physician assistant, lacks decision-making capacity, unless otherwise specified in the health care directive.”

Section 145C.06 states the rule from both ends: a directive is effective for a health care decision when it satisfies § 145C.03, subd. 1, and the principal, in the determination of the attending physician, APRN, or PA, “lacks decision-making capacity to make the health care decision; or if other conditions for effectiveness otherwise specified by the principal have been met.” And it stops being effective when the principal “recovers decision-making capacity.” “Decision-making capacity” is defined at § 145C.01, subd. 1b, as “the ability to understand the significant benefits, risks, and alternatives to proposed health care and to make and communicate a health care decision.”

Section 145C.07, subd. 1, puts the corresponding obligation on the clinician: the provider “shall continue to obtain the principal’s informed consent to all health care decisions for which the principal has decision-making capacity, unless other conditions for effectiveness otherwise specified by the principal have been met.”

You can override the default in both directions. Section 145C.05, subd. 2(c), is one sentence and it is the least-known provision in the chapter: “A health care directive may authorize a health care agent to make health care decisions for a principal even though the principal retains decision-making capacity.” A directive can hand your agent concurrent authority — useful for a principal who is competent but wants someone else at the table, and dangerous if drafted without thought.

Section 145C.05, subd. 2(b), goes the other way, for principals who do not have an attending physician. A principal “who in good faith generally selects and depends upon spiritual means or prayer for the treatment or care of disease or remedial care and does not have an attending physician, advanced practice registered nurse, or physician assistant,” or who “in good faith does not generally select a physician, advanced practice registered nurse, or physician assistant or a health care facility for the principal’s health care needs,” may name an individual to determine the principal’s decision-making capacity. But the statute pulls the determination back to a clinician if the person is receiving care in a health care facility, and provides that if the named individual is not reasonably available, “an attending physician, advanced practice registered nurse, or physician assistant shall determine the principal’s decision-making capacity.”

“Reasonably available” is defined: “able to be contacted and willing and able to act in a timely manner considering the urgency of the principal’s health care needs.” § 145C.01, subd. 9.

What can a Minnesota directive contain?

Section 145C.05, subd. 2(a), lists twelve categories, “including, but not limited to.” The list is worth reading in full, because most people use two of the twelve:

1. designation of one or more alternate agents to act if the named agent is not reasonably available;
2. directions to joint agents on the process or standards for reaching a decision, and whether joint agents may act independently;
3. limitations on the agent’s right to receive, review, obtain copies of, and consent to disclosure of medical records, or to visit the principal in a facility;
4. limitations on nomination of the agent as guardian under §§ 524.5-202, 524.5-211, 524.5-302, and 524.5-303;
5. a document of gift for an anatomical gift under chapter 525A, or an amendment, revocation, or refusal;
6. a declaration regarding intrusive mental health treatment under § 253B.03, subd. 6d, or a statement authorizing the agent to consent under § 253B.04, subd. 1a;
7. a funeral directive as provided in § 149A.80, subd. 2;
8. limitations on the effect of dissolution, annulment, or termination of a domestic partnership on the agent’s appointment under § 145C.09, subd. 2;
9. specific reasons why the principal wants an attending provider or provider’s employee to be eligible to serve as agent;
10. health care instructions by a woman of childbearing age regarding how she would like a pregnancy to affect decisions made on her behalf;
11. health care instructions regarding artificially administered nutrition or hydration; and
12. health care instructions to prohibit administering, dispensing, or prescribing an opioid — with a carve-out: those instructions “must not be construed to limit the administering, dispensing, or prescribing an opioid to treat substance abuse, opioid dependence, or an overdose, unless otherwise prohibited in the health care directive.”

Items 10 and 11 are not optional in any practical sense, for reasons the presumption section below makes clear. Item 7 is the funeral appointment; we treat it at length in who controls a body in Minnesota under § 149A.80, including what happens to a funeral directive when a marriage dissolves.

What a directive cannot do

It cannot authorize assisted suicide. The definition of “health care” at § 145C.01, subd. 4, excludes “any treatment, service, or procedure that violates the provisions of section 609.215 prohibiting assisted suicide.” The definition of “act in good faith” at subd. 1a closes the loop: “Notwithstanding any instruction of the principal, a health care agent, health care provider, or any other person is not acting in good faith if the person violates the provisions of section 609.215 prohibiting assisted suicide.” And § 145C.14 states flatly: “Nothing in this chapter may be construed to condone, authorize, or approve mercy killing or euthanasia.”

It does not reach your money or your property. “Health care” under § 145C.01, subd. 4, is “any care, treatment, service, or procedure to maintain, diagnose, or otherwise affect a person’s physical or mental condition,” and it “includes the provision of nutrition or hydration parenterally or through intubation.” It also “includes the establishment of a person’s abode within or without the state and personal security safeguards for a person, to the extent decisions on these matters relate to the health care needs of the person.” That qualifier is doing real work. Deciding where you live for care purposes is within the agent’s reach; selling the house to pay for it is not. For that you need a power of attorney under chapter 523 — see our Minnesota power of attorney guide — and, where a disabled beneficiary’s public benefits are in play, a supplemental needs trust put in place before the money arrives.

What is my agent actually allowed to do — and required to do?

Authority. Section 145C.07, subd. 1: the agent “has authority to make any particular health care decision only if the principal lacks decision-making capacity, in the determination of the attending physician, advanced practice registered nurse, or physician assistant, to make or communicate that health care decision; or if other conditions for effectiveness otherwise specified by the principal have been met.” An alternate agent “has authority to act if the primary health care agent is not reasonably available to act.”

Medical records. Section 145C.08 gives the agent “the same right as the principal to receive, review, and obtain copies of medical records of the principal, and to consent to the disclosure of medical records of the principal, unless the principal has otherwise specified in the health care directive.”

Visitation, even while you still have capacity. Section 145C.07, subd. 5, provides that an agent “may visit the principal when the principal is a patient in a health care facility regardless of whether the principal retains decision-making capacity,” subject to three exceptions: the principal specified otherwise in the directive; a principal who retains decision-making capacity indicates otherwise; or a provider “reasonably determines that the principal must be isolated from all visitors or that the presence of the health care agent would endanger the health or safety of the principal, other patients, or the facility in which the care is being provided.”

Duty — and the sentence that surprises people. Section 145C.07, subd. 3: “In exercising authority under a health care directive, a health care agent has a duty to act in good faith. A health care agent or any alternate health care agent has a personal obligation to the principal to make health care decisions authorized by the health care power of attorney, but this obligation does not constitute a legal duty to act.”

Your agent must act in good faith if they act. They are not legally obligated to act at all. That is why naming alternates under § 145C.05, subd. 2(a)(1), is not boilerplate, and why the person you name should be told, in advance, that they have been named.

“Act in good faith” has a statutory definition, and it is a hierarchy. Section 145C.01, subd. 1a, means acting “consistently with a legally sufficient health care directive of the principal, a living will executed under chapter 145B, a declaration regarding intrusive mental health treatment executed under section 253B.03, subdivision 6d, or information otherwise made known by the principal, unless the actor has actual knowledge of the modification or revocation of the information expressed.” Only “[i]f these sources of information do not provide adequate guidance to the actor” does good faith mean “acting in the best interests of the principal, considering the principal’s overall general health condition and prognosis and the principal’s personal values to the extent known.”

Substituted judgment first. Best interests only when the record runs out. Which is an argument for writing more into the instruction section, not less.

Does my agent automatically become my guardian?

The appointment operates as a nomination. Section 145C.07, subd. 2: “Unless the principal has otherwise specified in the health care directive, the appointment of the health care agent in a health care directive is considered a nomination of a guardian for purposes of sections 524.5-101 to 524.5-502.” Section 145C.05, subd. 2(a)(4), lets you limit that if you want the two roles in different hands.

A nomination is not an appointment. But in a contested guardianship it is the document that tells the court whom the respondent chose while competent — and it is the document that supports the argument that a guardianship is unnecessary in the first place.

The asymmetry: a duty to treat, only immunity to stop

This is the part of chapter 145C that most consumer summaries leave out.

If your agent directs life-sustaining care, the provider has an affirmative duty. Minn. Stat. § 145C.15(a):

“If a proxy acting under chapter 145B or a health care agent acting under this chapter directs the provision of health care, nutrition, or hydration that, in reasonable medical judgment, has a significant possibility of sustaining the life of the principal or declarant, a health care provider shall take all reasonable steps to ensure the provision of the directed health care, nutrition, or hydration if the provider has the legal and actual capability of providing the health care either itself or by transferring the principal or declarant to a health care provider who has that capability. Any transfer of a principal or declarant under this paragraph must be done promptly and, if necessary to preserve the life of the principal or declarant, by emergency means. This paragraph does not apply if a living will under chapter 145B or a health care directive indicates an intention to the contrary.”

Paragraph (b) extends it: an unwilling provider who has the capability may transfer the patient, “but the provider shall take all reasonable steps to ensure provision of the directed health care until the principal or declarant is transferred.” Paragraph (c) preserves the provider’s position on payment.

If your agent directs that life-sustaining care stop, the provider gets immunity for complying — and equal immunity for refusing. Section 145C.11, subd. 2(b), immunizes a provider who relies on an agent’s decision, on two good-faith conditions. But subd. 2(c) immunizes the opposite choice:

“A health care provider who administers health care necessary to keep the principal alive, despite a health care decision of the health care agent to withhold or withdraw that treatment, is not subject to criminal prosecution, civil liability, or professional disciplinary action if that health care provider promptly took all reasonable steps to: (1) notify the health care agent of the health care provider’s unwillingness to comply; (2) document the notification in the principal’s medical record; and (3) permit the health care agent to arrange to transfer care of the principal to another health care provider willing to comply with the decision of the health care agent.”

Compare the two obligations. Directed toward treatment, the provider must take all reasonable steps to deliver it or transfer, promptly and by emergency means if life is at stake. Directed away from treatment, the provider who declines must notify, document, and permit the agent to arrange a transfer — the arranging falls to the agent.

That difference is a drafting instruction. If you want treatment stopped in defined circumstances, say so in your own words in the instruction section, name those circumstances, and address artificially administered nutrition and hydration explicitly under § 145C.05, subd. 2(a)(11). A directive that only appoints an agent leaves your agent arguing in a hallway.

And if you are pregnant, there is a statutory presumption running the other way. Minn. Stat. § 145C.10(g):

“When a patient lacks decision-making capacity and is pregnant, and in reasonable medical judgment there is a real possibility that if health care to sustain her life and the life of the fetus is provided the fetus could survive to the point of live birth, the health care provider shall presume that the patient would have wanted such health care to be provided, even if the withholding or withdrawal of such health care would be authorized were she not pregnant.”

The subdivision then says how to displace it: “This presumption is negated by health care directive provisions described in section 145C.05, subdivision 2, paragraph (a), clause (10), that are to the contrary, or, in the absence of such provisions, by clear and convincing evidence that the patient’s wishes, while competent, were to the contrary.” Clause (10) is the pregnancy-instruction clause. This is the single most concrete reason for a woman of childbearing age to include one: without it, the alternative burden is clear and convincing evidence, gathered under time pressure.

The other presumptions in § 145C.10

They all run toward giving the document effect, and each is rebuttable only by clear and convincing evidence:

• The principal “is presumed to have the capacity to execute a health care directive and to revoke a health care directive,” absent clear and convincing evidence to the contrary. § 145C.10(a).
• A provider or agent “may presume that a health care directive is legally sufficient absent actual knowledge to the contrary,” and the directive “is presumed to be properly executed,” absent clear and convincing evidence to the contrary. § 145C.10(b).
• The agent, and a provider acting at the agent’s direction, “are presumed to be acting in good faith,” absent clear and convincing evidence to the contrary. § 145C.10(c).
• The directive “is presumed to remain in effect until the principal modifies or revokes it,” absent clear and convincing evidence to the contrary. § 145C.10(d).
• A copy is as good as the original. “A copy of a health care directive is presumed to be a true and accurate copy of the executed original, absent clear and convincing evidence to the contrary, and must be given the same effect as an original.” § 145C.10(f).

That last one is practical advice in statutory form. Distribute copies — to the agent, to the alternates, to the clinic. There is no reason to keep the only executed original in a safe deposit box nobody can open on a Saturday.

How do I revoke or change it?

Four ways, under § 145C.09, subd. 1, available to “[a] principal with the capacity to do so,” “in whole or in part at any time”:

1. destroying the instrument — “canceling, defacing, obliterating, burning, tearing, or otherwise destroying” it, or directing another to do so in the principal’s presence, “with the intent to revoke the health care directive in whole or in part”;
2. “executing a statement, in writing and dated, expressing the principal’s intent to revoke the health care directive in whole or in part”;
3. “verbally expressing the principal’s intent to revoke the health care directive in whole or in part in the presence of two witnesses who do not have to be present at the same time”; or
4. “executing a subsequent health care directive, to the extent the subsequent instrument is inconsistent with any prior instrument.”

Route 3 deserves a second look. An oral revocation in front of two witnesses — who need not be together — revokes. There is no filing, no notice requirement, and no writing. That is by design, because a person in a hospital bed may have no other means. It is also why the “actual knowledge” qualifier in § 145C.10(b) and § 145C.11, subd. 2(b)(1), matters: a provider’s protection depends on having no actual knowledge that the directive was revoked.

Divorce revokes a spouse’s appointment automatically under § 145C.09, subd. 2, “[u]nless the principal has otherwise specified” — and the trigger is the commencement of dissolution, annulment, or domestic-partnership-termination proceedings, not the decree. We discuss the unresolved edge of that rule — its effect on a funeral directive included in the same document — in the § 149A.80 article.

A court can declare a directive unenforceable, but only on narrow grounds. Section 145C.09, subd. 3: a court may do so “if it finds, by clear and convincing evidence, that the health care directive was executed under coercion or fraudulent inducement as prohibited by section 145C.13, subdivision 1, clause (4), or if it finds that the health care directive is not legally sufficient under section 145C.03 or 145C.04.”

When documents conflict, the most recent wins — but only to the extent of the conflict. Section 145C.07, subd. 4: as between the appointment of a proxy under chapter 145B or § 253B.03, subd. 6d, and a health care agent under chapter 145C, “the most recent appointment takes precedence.” For other inconsistencies among documents executed under chapter 145C, chapter 145B, § 253B.03, subd. 6d, §§ 524.5-101 to 524.5-502, “or other legally sufficient documents, the provisions of the most recently executed document take precedence only to the extent of the inconsistency.”

That is not a clean-slate rule. An old document survives everywhere it does not conflict. If you are replacing a directive, revoke the old one expressly under § 145C.09, subd. 1(2), rather than relying on implied supersession.

A POLST is not a health care directive

They get conflated constantly, and the distinction is structural: a health care directive is signed by you; a POLST is a medical order signed by a clinician.

Chapter 145C does not mention POLST anywhere. The only Minnesota enactment on the subject that I can locate is a study directive: 2023 Minn. Laws ch. 70, art. 4, § 100, which instructs the commissioner of health, in consultation with an advisory committee, to “develop recommendations for a statewide registry of POLST forms to ensure that a patient’s medical treatment preferences are followed by all health care providers.” That section defines POLST, for its own purposes, as “a provider order for life-sustaining treatment, signed by a physician, advanced practice registered nurse, or physician assistant, to ensure that the medical treatment preferences of a patient with an advanced serious illness who is nearing the end of life are honored,” and defines a “POLST form” as “a portable medical form used to communicate a physician’s, advanced practice registered nurse’s, or physician assistant’s order to help ensure that a patient’s medical treatment preferences are conveyed to emergency medical service personnel and other health care providers.”

Practically: a POLST travels with a seriously ill patient and tells EMS what to do in the next twenty minutes. A directive tells everyone who you are and who speaks for you, for the rest of your life, including decades before any POLST conversation happens. A POLST is not a substitute for a directive, and executing one does not revoke a directive under § 145C.09, subd. 1 — none of the four revocation routes describes signing a clinician’s order.

The nonopioid directive — new in 2025, already amended

Minnesota added a distinct instrument in 2025. A “nonopioid directive” is “a written instrument that includes one or more instructions that a patient must not be administered an opioid by a health professional or be offered a prescription for an opioid by a prescriber.” § 145C.01, subd. 7b.

Two features make it different from everything else in chapter 145C.

Your agent can execute it for you. Section 145C.18, subd. 1: “A patient with the capacity to do so may execute a nonopioid directive on the patient’s own behalf. A patient’s health care agent may execute a nonopioid directive on behalf of the patient.” Nowhere else in the chapter can an agent create the instrument.

It has to go into the chart, and the provider has to put it there. Section 145C.17: “A health care provider presented with a nonopioid directive executed by or on behalf of a patient must include the nonopioid directive in the patient’s health care record,” and a provider receiving notice of a revocation “must note the revocation in the patient’s health care record.” The same section requires a provider, at the request of the patient or agent, to enter into the record “any instructions relating to administering, dispensing, or prescribing an opioid.”

Revocation tracks who executed it. A patient who executed it personally “may revoke the nonopioid directive at any time and in any manner in which the patient is able to communicate an intent to revoke the nonopioid directive.” An agent who executed it on the patient’s behalf revokes “by executing a written, dated statement of revocation and by providing notice of the revocation to the patient’s health care provider.” § 145C.18, subd. 2.

Compliance is mandatory, subject to exceptions. Section 145C.18, subd. 3(b), permits an opioid where the patient is being treated in emergency circumstances, in or outside a hospital; the prescriber’s professional opinion is that it is medically necessary, “including but not limited to during a surgical procedure when one or more complications arise”; and “it is not practical or feasible for the prescriber or health professional to access the patient’s health care record.” If that happens, “the prescriber must ensure that the patient is provided with information on substance use disorder services.”

A second exception was added this year. 2026 Minn. Laws ch. 127, art. 14, § 5, adds § 145C.18, subd. 3(c): “A prescriber or a health professional acting on the order of a prescriber may prescribe or administer an opioid to a patient with a nonopioid directive if the opioid is prescribed or administered to treat the patient for a substance use disorder.” Section 6 of the same article extends the subd. 4 immunities to that conduct. Neither section carries an effective-date clause; chapter 127 is an act appropriating money, so Minn. Stat. § 645.02 supplies the default for such acts — “the beginning of the first day of July next following its final enactment.” Chapter 127 (S.F. 4612) was presented to the governor May 20, 2026, and final enactment — the signature, not the presentment — followed within the constitutional window that spring, which makes the operative date July 1, 2026.

Two verification notes for anyone relying on this. First, Revisor’s on-screen text of § 145C.18 is the 2025 Supplement version and does not yet display paragraph (c) — the section carries a 2026-session currency banner, and the amended language must be read from the session law. Second, the exception in § 145C.05, subd. 2(a)(12), already preserved opioid use “to treat substance abuse, opioid dependence, or an overdose” for instructions written into a directive; the 2026 amendment brings the standalone nonopioid directive into line with it.

Prohibited practices and penalties

Nobody can require you to have one — or forbid you from having one. Section 145C.12, subd. 1: a health care provider, health care service plan, insurer, self-insured employee welfare benefit plan, or nonprofit hospital plan “may not condition admission to a facility, or the providing of treatment or insurance, on the requirement that an individual execute a health care directive.” Subdivision 2 protects life insurance: a policy “is not legally impaired or invalidated in any manner by the withholding or withdrawing of health care pursuant to the direction of a health care agent appointed pursuant to this chapter,” or pursuant to health care instructions under the chapter.

Interfering with a directive is a crime. Section 145C.13, subd. 1, makes five acts a gross misdemeanor: willfully concealing, canceling, defacing, or obliterating a principal’s directive without consent; willfully concealing or withholding personal knowledge of a revocation; falsifying or forging a directive or a revocation; coercing or fraudulently inducing execution; and requiring or prohibiting execution as a condition of insurance or health care services. Subdivision 2 elevates any of those to a felony “if the act results in bodily harm to the principal or to the person who would have been a principal but for the unlawful act.”

The last phrase is worth pausing on. The felony reaches harm to someone who never got to execute a directive because of the unlawful act.

Madgett Law, LLC

Madgett Law, LLC drafts Minnesota health care directives under chapter 145C as part of estate planning — including the instruction sections most forms leave blank: artificially administered nutrition and hydration under § 145C.05, subd. 2(a)(11); the pregnancy instruction under clause (10) that displaces the § 145C.10(g) presumption; concurrent agent authority under § 145C.05, subd. 2(c); and coordination with a chapter 523 power of attorney, a § 149A.80 funeral appointment, and any trust in the plan. We also advise families facing the harder version of this problem — an incapacitated adult with no directive, where the only route is a guardianship petition, or a dispute between an agent and a provider under § 145C.15. Call 612-470-6529 or send us a message.

Sources: Minn. Stat. § 145C.01, subd. 1a (definition of “act in good faith”; substituted judgment first, best interests only if guidance is inadequate; assisted-suicide limit), subd. 1b (definition of “decision-making capacity”), subd. 2 (health care agent must be 18 or older), subd. 4 (definition of “health care”; nutrition and hydration included; abode and personal security only as they relate to health care needs; assisted-suicide exclusion), subd. 7b (definition of “nonopioid directive”), subd. 8 (principal must be 18 or older), subd. 9 (definition of “reasonably available”), https://www.revisor.mn.gov/statutes/cite/145C.01. Minn. Stat. § 145C.02 (who may execute; contents; default incapacity trigger determined by the attending physician, APRN, or PA), https://www.revisor.mn.gov/statutes/cite/145C.02. Minn. Stat. § 145C.03, subd. 1 (six legal-sufficiency requirements), subd. 2 (individuals ineligible to act as agent), subd. 3 (agent may not witness or notarize; at least one witness must not be a direct-care provider or employee; a notary may be such an employee), https://www.revisor.mn.gov/statutes/cite/145C.03. Minn. Stat. § 145C.04 (out-of-state directives sufficient if they comply with the law of the place of execution or with § 145C.03; assisted-suicide limit), https://www.revisor.mn.gov/statutes/cite/145C.04. Minn. Stat. § 145C.05, subd. 1 (the § 145C.16 form is optional), subd. 2(a)(1)–(12) (the twelve enumerated categories), subd. 2(b) (alternate capacity determiners for principals relying on spiritual means or without an attending clinician), subd. 2(c) (agent may act although the principal retains capacity), https://www.revisor.mn.gov/statutes/cite/145C.05. Minn. Stat. § 145C.06 (when effective; when it ceases to be effective on recovery of capacity), https://www.revisor.mn.gov/statutes/cite/145C.06. Minn. Stat. § 145C.07, subd. 1 (agent’s authority; alternate acts if the primary is not reasonably available; continuing duty to obtain the principal’s informed consent), subd. 2 (appointment is a nomination of guardian under §§ 524.5-101 to 524.5-502 unless otherwise specified), subd. 3 (duty of good faith; personal obligation that “does not constitute a legal duty to act”), subd. 4 (inconsistencies among documents; most recent takes precedence only to the extent of the inconsistency), subd. 5 (visitation and its three exceptions), https://www.revisor.mn.gov/statutes/cite/145C.07. Minn. Stat. § 145C.08 (agent’s right to medical records unless limited), https://www.revisor.mn.gov/statutes/cite/145C.08. Minn. Stat. § 145C.09, subd. 1(1)–(4) (four revocation routes, including oral revocation before two witnesses not required to be present at the same time), subd. 2 (revocation of a spouse’s or registered domestic partner’s appointment on commencement of dissolution, annulment, or termination proceedings), subd. 3 (court power to declare a directive unenforceable; clear and convincing evidence of coercion or fraudulent inducement, or legal insufficiency), https://www.revisor.mn.gov/statutes/cite/145C.09. Minn. Stat. § 145C.10(a)–(g) (presumptions; (e) no presumption for a person who executed no directive; (f) a copy has the same effect as an original; (g) the pregnancy presumption and the two ways to negate it), https://www.revisor.mn.gov/statutes/cite/145C.10. Minn. Stat. § 145C.11, subd. 1 (agent immunity for good-faith acts), subd. 2(a)–(b) (provider immunity for good-faith reliance), subd. 2(c) (immunity for a provider who keeps the principal alive despite the agent’s decision, on notice, documentation, and permitting transfer), https://www.revisor.mn.gov/statutes/cite/145C.11. Minn. Stat. § 145C.12, subds. 1–2 (no conditioning admission, treatment, or insurance on executing a directive; life insurance not impaired), https://www.revisor.mn.gov/statutes/cite/145C.12. Minn. Stat. § 145C.13, subds. 1–2 (five gross misdemeanor offenses; felony where the act results in bodily harm), https://www.revisor.mn.gov/statutes/cite/145C.13. Minn. Stat. § 145C.14 (chapter does not condone mercy killing or euthanasia), https://www.revisor.mn.gov/statutes/cite/145C.14. Minn. Stat. § 145C.15(a)–(c) (duty to provide directed life-sustaining health care, nutrition, or hydration; prompt transfer, by emergency means if necessary; unwilling provider must continue until transfer; payment obligations unaffected), https://www.revisor.mn.gov/statutes/cite/145C.15. Minn. Stat. § 145C.16 (suggested form; Part III execution instructions and the Option 2 two-witness attestations), https://www.revisor.mn.gov/statutes/cite/145C.16. Minn. Stat. § 145C.17 (opioid instructions and nonopioid directives entered into the health record; revocation noted), https://www.revisor.mn.gov/statutes/cite/145C.17. Minn. Stat. § 145C.18, subds. 1–5 (execution by patient or agent; revocation; compliance and the emergency exception; immunities; commissioner’s form), https://www.revisor.mn.gov/statutes/cite/145C.18, as amended by 2026 Minn. Laws ch. 127, art. 14, §§ 5–6 (adding subd. 3(c), the substance-use-disorder exception, and conforming the subd. 4 immunities; no effective-date clause), https://www.revisor.mn.gov/laws/2026/0/Session+Law/Chapter/127/. Minn. Stat. § 645.02 (August 1 default; July 1 default for an appropriation act or an act having appropriation items), https://www.revisor.mn.gov/statutes/cite/645.02; chapter 127 (S.F. 4612) presentment date May 20, 2026, with final enactment following that spring, https://www.revisor.mn.gov/laws/2026/0/. Minn. Stat. § 145B.011 (chapter 145B applies only to living wills executed before August 1, 1998), § 145B.12, subd. 1 (no presumption where no living will), subd. 2 (chapter does not authorize withholding or withdrawing artificially administered nutrition or hydration from a person who issued no living will or proxy), § 145B.17 (existing rights preserved), https://www.revisor.mn.gov/statutes/cite/145B.011, https://www.revisor.mn.gov/statutes/cite/145B.12, and https://www.revisor.mn.gov/statutes/cite/145B.17. Minn. Stat. § 524.5-313(a)–(c) (guardian subject to the court’s control; only powers necessary for demonstrated needs; clause (4)(i) consent power and its court-approval exceptions and conscientious-belief limit), https://www.revisor.mn.gov/statutes/cite/524.5-313. Minn. Stat. § 253B.04, subd. 1a (designated agency consent for mental health treatment or admission “in the absence of a health care directive or health care power of attorney that authorizes consent”), subd. 1b (court appointment of a substitute decision maker), https://www.revisor.mn.gov/statutes/cite/253B.04. 2023 Minn. Laws ch. 70, art. 4, § 100 (POLST registry study; statutory definitions of “POLST” and “POLST form”), https://www.revisor.mn.gov/laws/2023/0/Session+Law/Chapter/70/. This article is general legal information about Minnesota law. It is not legal advice, it does not create an attorney–client relationship, and no particular outcome is promised or implied.