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SB 1411

HEALTH CARE SURROGATE-POLST

104th Regular Session Introduced by Margaret Croke and 4 co-sponsors

Clarifies that a living will activates only after four conditions are met, prioritizes the health-care agent's authority, and lets surrogates use POLST for incapacitated patients.

Public Act . . . . . . . . . 104-0378
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Bill Summary · SB 1411

SB 1411 — Summary (Public Act 104‑0378)

Status: Enacted as Public Act 104‑0378; approved by Governor (8/15/2025). Effective date: January 1, 2026.

Purpose

SB 1411 revises the Illinois Living Will Act and the Health Care Surrogate Act to clarify how living wills, health‑care agents (powers of attorney), surrogate decision‑makers, and POLST (portable medical orders) interact. The amendments set objective conditions for when a living will becomes operative, protect agent and surrogate authority, and address use and recognition of POLST forms and electronic declarations.

Key provisions and statutory changes

  • Illinois Living Will Act (amends 755 ILCS 35)

    • Adds Sec. 3.5 (755 ILCS 35/3.5): Applicability when a patient has a health‑care agency.
    • Section 4‑11 of the Illinois Power of Attorney Act governs applicability where a patient has an agent.
    • A living‑will declaration is not operative so long as an agent authorized by a health‑care agency is available to make decisions regarding life‑sustaining or death‑delaying procedures. The amendments do not impair or supersede an agent’s authority.
    • Revises General Provisions (755 ILCS 35/9):
    • Confirms electronic documents, signatures, and revocations are allowed (technology‑neutral standard; UETA compliance).
    • Prohibits providers or insurers from requiring a POLST (or similar form) to put a qualified patient's living‑will declaration into effect.
    • Requires providers to rely on and comply with an apparent and immediately available qualified patient’s declaration when the patient lacks decision‑making ability.
    • Reiterates that nothing in the Act supersedes surrogate authority under the Health Care Surrogate Act.
    • Adds Sec. 9.5 (755 ILCS 35/9.5): Operation of living will.
    • A living will becomes operative only when all four conditions are met: (1) valid execution, (2) not revoked per Section 5, (3) patient cannot give directions about life‑sustaining/death‑delaying procedures, and (4) patient is a “qualified patient.” An operative declaration remains in effect until revoked.

  • Health Care Surrogate Act (amends 755 ILCS 40)

    • Sec. 15 (Applicability): Clarifies the Surrogate Act does not apply where there is an operative and unrevoked living will, declaration for mental health treatment, or an authorized agent under a power of attorney for health care, to the extent those instruments cover the patient’s condition — except as otherwise provided (see Sec. 65).
    • Sec. 65 (POLST / Department of Public Health Uniform POLST form):
    • Confirms POLST execution is voluntary; providers/facilities cannot require POLST for services.
    • Defines “POLST” / “POLST portable medical orders form” and recognizes out‑of‑state POLST/DNR orders that are apparent and immediately available.
    • New subsection (c‑5): If an individual without decisional capacity has an operative and unrevoked living will, and the attending physician documents the individual has a terminal condition (per Living Will Act Sec. 4), then the surrogate (in the priority order under Sec. 25) is authorized to consent to a POLST on the individual’s behalf to ensure the individual’s wishes are honored.
    • Presumption of validity for completed POLST or equivalent forms and good‑faith protections for providers who comply.

Who is affected

  • Patients who have executed living wills, POLST forms, or powers of attorney for health care.
  • Health‑care agents (appointed under powers of attorney), surrogate decision‑makers, attending physicians, health‑care providers and facilities.
  • Health systems that implement POLST procedures and medical record systems (including electronic signature/recording processes).
  • Insurers/health plans to the extent the bill bars requiring declarations/POLST as a condition for coverage or services.

Practical impacts

  • Clarifies that a living will does not automatically operate if a designated agent is available and authorized — prioritizes agent authority under a health‑care agency.
  • Establishes explicit operational criteria for when living wills become effective.
  • Enables surrogates to execute POLSTs for incapacitated patients who have operative living wills and documented terminal conditions, helping translate advance directives into actionable medical orders.
  • Supports electronic execution and revocation of living‑will documents consistent with UETA standards.
  • Provides legal protection for providers relying in good faith on POLSTs or living‑will declarations that are apparent and immediately available.

Statutory references

  • Living Will Act: 755 ILCS 35 (new sections 3.5 and 9.5; amended Section 9)
  • Health Care Surrogate Act: 755 ILCS 40 (amended Sections 15 and 65)

If you want, I can prepare a one‑page plain‑language explainer for patients or a checklist for health‑care providers summarizing when a living will is operative and when an agent or surrogate may act.

Compiled from official sources — confirm details with the bill’s official record.

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