1. What are the considerations under which an advance directive can be implemented?

The person designated as Patient Advocate for Health Care may make decisions about health care for the patient when the patient can no longer speak for him/herself.  The requirement is being unable to make one’s own medical decisions; it does not require the condition to be terminal or death to be imminent.

2. In the case of conflicts which document overrides – the living will or the durable power of attorney?

Michigan does not have a statute governing the use of Living Wills.  It is recommended that the patient complete a Living Will along with the Patient Advocate Designation to ensure the advocate has enough guidance about the patient’s wishes and to ensure that the desired medical care is received.

3. What is the authority of a living will; of a durable power of attorney, i.e., the attorney- in- fact?

Michigan does not have a statute governing the use of Living Wills.
The durable power of attorney is called a Designation of Patient Advocate for Health Care and the person(s) must be designated by a form signed by the patient and two witnesses as well as an acceptance of the responsibility signed by the designated Patient Advocate and alternate if any.  It is legally binding and becomes effective when the patient’s doctor and one additional doctor or psychologist examine the patient and determine that the patient is unable to make medical treatment decisions.  This written determination of inability must be in writing and made a part of the patient’s medical record.  It must be reviewed at least annually.  The patient must be at least 18 years old and not pregnant.  The patient does not have to be in a terminal condition.

4. Can the physician (or healthcare facility) override an advance directive?

If the form designating a Patient Advocate has been properly executed, the advocate is available to serve, the patient is not pregnant, and two doctors have entered a written designation of “inability to make medical decisions”, the patient’s wishes as interpreted by the Patient Advocate are legally binding in Michigan and should be honored without exception.

5. What is the definition of a terminal illness?

Michigan law does not define terminal illness because a terminal condition is not required for the Patient Advocate to be implemented and there is not a statute governing the use of a Living Will.

6. How is the persistent vegetative state (permanent unconsciousness) considered in the advance directive legislation?

Persistent vegetative state is not addressed in Michigan statutes.

7. Does the advance directive require/allow certain specific interventions or conditions to be addressed?

No.  The Michigan statute allows for a designation of a Patient Advocate and it is recommended that no specific instructions be added to the designation form.  A Living Will may be completed in addition to the designation of the Patient Advocate and specific conditions or medical treatments may be addressed in the Living Will, but the statute does not cover it.

8. Is artificially administered nutrition and hydration specifically addressed in the legislation?

No, it is not covered.

9. Is the possible pregnancy of the patient addressed in the legislation?

Yes.  A Patient Advocate does not have the authority to decide to withhold or withdraw medical treatment from a pregnant woman.

10. Is there a special form (or special language) required for the advance directive?

Yes.  The state provides the form: Michigan Designation of Patient Advocate for Health Care.  Photostat copies of the properly signed and witnessed document will have the same legal force as the original document.

11. Is a supplemental document expressing more specific or more extensive wishes of the patient allowed?

Yes.  A Living Will may also be executed with more detailed instructions.  However, Michigan Law does not specifically address the Living Will.

12. Are there any curious features about the state’s advance directive legislation?

None.