MICHIGAN LIVING WILL / ADVANCE HEALTH CARE DIRECTIVE

(a/k/a “Patient Advocate Designation” under Mich. Comp. Laws § 700.5506 et seq.)

[// GUIDANCE: This template is drafted to comply with Michigan’s Estates and Protected Individuals Code (“EPIC”) provisions on health-care powers of attorney (Mich. Comp. Laws § 700.5506 – 5513) and the federal Patient Self-Determination Act. Customize bracketed items, review all statutory cross-references, and confirm current witness-qualification rules before execution.]

TABLE OF CONTENTS

I. Document Header
II. Definitions
III. Operative Provisions
IV. Representations & Warranties
V. Covenants & Restrictions of Patient Advocate
VI. Default & Remedies
VII. Risk Allocation
VIII. Dispute Resolution
IX. Revocation & Amendment
X. General Provisions
XI. Execution Block (including Patient Advocate Acceptance & Witness Attestation)

I. DOCUMENT HEADER

1. Title.
   MICHIGAN LIVING WILL / ADVANCE HEALTH CARE DIRECTIVE (Patient Advocate Designation)

2. Declarant.
   This Advance Directive (“Directive”) is made by [FULL LEGAL NAME OF DECLARANT], residing at [ADDRESS] (“Declarant”).

3. Effective Date & Governing Law.
   This Directive is effective on the date of the Declarant’s signature below and is governed by the laws of the State of Michigan, including but not limited to Mich. Comp. Laws § 700.5506 et seq.

4. Recitals.
   A. Declarant is of sound mind, acting voluntarily, and desires to direct future health-care decisions and to appoint a patient advocate to act during periods when Declarant lacks decisional capacity.
   B. Declarant intends this Directive to constitute a “patient advocate designation” and “durable power of attorney for health care” under Michigan law.

II. DEFINITIONS

For purposes of this Directive, capitalized terms have the meanings set forth below:

“Advance Directive” or “Directive” – This document, including all attachments, schedules, and later amendments.
“Attending Physician” – The physician who has primary responsibility for Declarant’s care.
“Decision-Making Capacity” – Declarant’s ability to understand, appreciate, and communicate an informed choice regarding medical treatment, as determined under Mich. Comp. Laws § 700.5508(1).
“Life-Sustaining Treatment” – Any medical procedure, device, or medication that, when administered, serves only to postpone the moment of death.
“Patient Advocate” – The individual appointed in Section III.A to make health-care decisions on Declarant’s behalf.
“Successor Advocate” – A back-up patient advocate designated in Section III.B who may act if the Patient Advocate is unable, unwilling, or ineligible.
“Good-Faith Standard” – The standard of honest belief and reasonable diligence consistent with Mich. Comp. Laws § 700.5510(1).
“Witness” – An individual qualified under Mich. Comp. Laws § 700.5506(4) to witness execution of this Directive.

III. OPERATIVE PROVISIONS

A. Appointment of Patient Advocate.
1. Declarant hereby appoints [NAME], residing at [ADDRESS], telephone [PHONE], as Patient Advocate with full authority to make decisions relating to Declarant’s health care, mental-health care, and anatomical gifts as permitted by law.
2. Scope of Authority. Subject to Section V and Declarant’s expressed wishes herein, the Patient Advocate may:
a. Consent to, refuse, or withdraw any medical or surgical procedure, including Life-Sustaining Treatment;
b. Employ and discharge health-care providers;
c. Admit Declarant to or discharge Declarant from any health-care facility;
d. Review and obtain all medical records;
e. Execute waivers, releases, or indemnity agreements required by providers acting in good faith.

B. Successor Advocate(s).
1. First Successor: [NAME / ADDRESS / PHONE]
2. Second Successor (optional): [NAME / ADDRESS / PHONE]
A Successor Advocate may act only if every previously-named advocate is unwilling, unavailable, or disqualified.

C. Statement of Preferences.
1. End-of-Life Care. If I am permanently unconscious, terminally ill with no reasonable expectation of recovery, or suffer irreversible loss of Decision-Making Capacity, [SELECT ONE: I do / I do NOT] authorize my Patient Advocate to withhold or withdraw Life-Sustaining Treatment, including artificial nutrition and hydration.
2. Pain Management. I direct that pain relief be provided to keep me comfortable even if it may hasten my death.
3. Organ & Tissue Donation. [SELECT ONE: I authorize / I do NOT authorize] the Patient Advocate to consent to anatomical gift(s) in accordance with my wishes and Michigan’s Revised Uniform Anatomical Gift Act.
4. Religious / Moral Directives. My care must be consistent with the following beliefs or practices: [INSERT OR “None”].

D. Determination of Incapacity.
This Directive becomes operative when both (i) my Attending Physician and (ii) another physician or licensed psychologist document in writing that I lack Decision-Making Capacity.

E. Good-Faith Reliance.
Any third party may rely on a copy of this Directive and the Patient Advocate’s representations without further inquiry into validity, so long as reliance is in good faith.

IV. REPRESENTATIONS & WARRANTIES

Declarant represents and warrants that:
1. Capacity & Voluntariness. Declarant is at least 18 years old, of sound mind, and executing this Directive voluntarily.
2. No Undue Influence. Execution is free from fraud, duress, or undue influence.
3. Completeness. The information supplied herein is true, correct, and complete to the best of Declarant’s knowledge.

V. COVENANTS & RESTRICTIONS OF PATIENT ADVOCATE

The Patient Advocate shall:
1. Act in accordance with Declarant’s stated wishes, values, and best interests, and within the Good-Faith Standard.
2. Consult with health-care professionals as needed and keep contemporaneous records of major decisions.
3. Not exercise any power that Declarant—if competent—could not exercise personally.
4. Refrain from delegating authority to another person.
5. Cease acting immediately upon written or oral notice of revocation or upon knowledge that this Directive has otherwise terminated.

VI. DEFAULT & REMEDIES

1. Failure or Refusal to Act. If the Patient Advocate fails or refuses to act, authority passes automatically to the highest-priority available Successor Advocate identified in Section III.B.
2. Judicial Relief. Any interested person may petition a court of competent jurisdiction for injunctive or declaratory relief to:
   a. Compel compliance with this Directive;
   b. Remove a Patient Advocate for breach of duty; or
   c. Appoint a guardian in accordance with Mich. Comp. Laws § 700.5313.
3. Attorney Fees. A prevailing party in litigation to enforce or invalidate this Directive may recover reasonable attorney fees and costs where authorized by statute or court order.

VII. RISK ALLOCATION

1. Indemnification of Providers. Declarant agrees to indemnify and hold harmless health-care providers acting in good-faith reliance on this Directive against any liability, loss, or expense (including reasonable attorney fees) arising from such reliance, except for gross negligence or willful misconduct.
2. Limitation of Liability. To the fullest extent permitted by law, neither the Patient Advocate nor any provider shall be liable for acts or omissions made in good faith pursuant to this Directive.

[// GUIDANCE: Michigan law already affords broad statutory immunity for good-faith reliance (see Mich. Comp. Laws § 700.5510). This contractual provision supplements, but does not limit, that immunity.]

3. Force Majeure. Neither Declarant nor Patient Advocate shall be liable for non-performance caused by events beyond reasonable control, including but not limited to natural disasters, war, terrorism, or widespread communicable disease outbreaks.

VIII. DISPUTE RESOLUTION

1. Governing Law. This Directive and all disputes arising hereunder shall be governed by the internal laws of the State of Michigan, without regard to conflict-of-law principles.
2. Forum Selection. Any action shall be brought in a Michigan state court of competent jurisdiction.
3. Arbitration; Jury Trial. Declarant does not consent to binding arbitration or waiver of jury trial with respect to enforcement of this Directive.
4. Injunctive Relief. The availability of injunctive relief to enforce or prevent violation of this Directive is expressly preserved.

IX. REVOCATION & AMENDMENT

1. Revocation by Declarant. Declarant may revoke this Directive, including the Patient Advocate’s authority, at any time by one of the following methods:
   a. A signed, dated writing;
   b. An oral statement in the presence of two adults;
   c. Any other act evidencing intent to revoke (e.g., destroying the document).
2. Automatic Revocation.
   a. Divorce or Annulment. If the Declarant’s spouse is named Patient Advocate, appointment is revoked upon entry of a judgment of divorce or annulment, unless Declarant separately re-affirms the designation.
   b. Subsequent Directive. Execution of a later-dated advance directive automatically supersedes inconsistent provisions herein.
3. Notice of Revocation. Declarant bears responsibility to communicate revocation to the Patient Advocate and primary health-care providers.
4. Amendment. Declarant may amend this Directive only by executing a written instrument with the same formalities required for the original execution.

X. GENERAL PROVISIONS

1. Severability. If any provision is held unenforceable, the remaining provisions shall remain in full force, and the invalid provision shall be construed, if possible, to reflect original intent.
2. Integration / Merger. This Directive constitutes the entire understanding regarding the subject matter and supersedes all prior oral and written directives.
3. Copies & Electronic Signatures. A copy, facsimile, or electronically-signed version of this Directive shall have the same legal effect as an original.
4. Successors & Assigns. The rights and obligations herein bind and benefit Declarant, Patient Advocate(s), and their respective successors and assigns, subject to statutory limitations on delegation.
5. Amendment & Waiver. No amendment or waiver is effective unless in writing and executed with the same witness formalities as this Directive.

XI. EXECUTION BLOCK

A. DECLARANT’S SIGNATURE & REQUIRED STATUTORY STATEMENT

[// GUIDANCE: The following language tracks the statutory notice required by Mich. Comp. Laws § 700.5507(1); do not materially alter.]

“I voluntarily sign this patient advocate designation. I understand that the person I designate here has power to make care, custody, and medical treatment decisions for me if I am unable to participate in those decisions. I may revoke this designation at any time and in any manner sufficient to communicate my intent. My patient advocate must act consistent with my wishes as I have expressed them in this document or as I communicate to my patient advocate. My patient advocate may make a decision to withhold or withdraw treatment that would allow me to die only if I have expressed in this document that I desire such a decision. I understand that my patient advocate cannot make a decision that I, if able, could not have made for myself.”

____ ___
[DECLARANT NAME]        Date

B. PATIENT ADVOCATE ACCEPTANCE

[// GUIDANCE: Acceptance must be signed, dated, and include the statutory acknowledgement.]

“I accept the designation as patient advocate and agree to act in the Declarant’s best interests, consistent with the Declarant’s known wishes and Michigan law. I understand and will comply with the duties and limitations imposed by Mich. Comp. Laws § 700.5506 et seq.”

____ ___
[ADVOCATE NAME]       Date

C. SUCCESSOR ADVOCATE(S) ACCEPTANCE

(Optional – replicate acceptance language above for each Successor Advocate.)

D. WITNESS ATTESTATION

We declare that the Declarant is personally known to us, appears to be of sound mind, signed or acknowledged this Directive in our presence, and did so voluntarily. We further declare that we are not:
• The Declarant’s spouse, parent, child, grandchild, sibling, presumptive heir, or known beneficiary;
• The named Patient Advocate or Successor Advocate;
• A physician, licensed health-care professional, or employee of a facility currently treating the Declarant;
• A life or health insurance agent of the Declarant;
• A person financially responsible for the Declarant’s care.

E. NOTARIZATION (Optional but Recommended)

State of Michigan )
County of ____ )

On this _ day of __, 20__, before me, a Notary Public, personally appeared [Declarant Name], known to me (or satisfactorily proven) to be the person who executed the foregoing Advance Directive, and acknowledged that it was executed as Declarant’s free and voluntary act.

Notary Public, State of Michigan
My commission expires: _
Acting in the County of _

[// GUIDANCE:
1. Store originals in a readily accessible location; provide copies to the Patient Advocate, Successor Advocate(s), primary physician, and healthcare facility.
2. Consider uploading a digital copy to the Michigan Health Information Network (MiHIN) or other state-approved registry.
3. Review this Directive periodically and after major life events (marriage, divorce, diagnosis, etc.).]