CLINICAL ETHICS CENTER at Memorial Medical Center

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Because the symptoms of a mental disorder might make you unable to express your true wishes about mental health treatment, you can specify in advance your preference for mental health treatment in a Declaration for Mental Health Treatment. The Declaration allows you to name the specific symptoms for which you would want or not want mental health treatment.

Conditions of Application:
When the patient is unable to make treatment decisions due to the symptoms of a mental disorder
Consent /Refusal for:
ECT
Psychotropic drugs
Admission to/retention in a mental health treatment facility
How Preferences Are Expressed:
An agent may be appointed by the patient in the document to make decisions; Preferences for/against treatment may be declared
How Document Is Revoked:
Must be revoked in writing; Can only be revoked when the patient is able to make decisions (as determined by a physician)

All of the advance directive forms are Adobe Acrobat files and require Adobe Acrobat Reader to open them. If you do not have Adobe Acrobat Reader installed on your computer, click here for a free downloadable Adobe Acrobat Reader copy.

Illinois Declaration for Mental Health Treatment Form (PDF Format)

Illinois Declaration for Mental Health Treatment Form (Spanish) (PDF Format)

Questions or comments - email us at Clinical Ethics Center
Last Updated May 24, 2012
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