Michigan Patient Advocate Designation, Explained
General information only, not legal advice. See the disclosure at the end.
In Michigan, the document that names someone to make medical decisions for you if you can't make them yourself is called a patient advocate designation. Other states may call it a health care power of attorney or health care proxy. Michigan's rules are in the Estates and Protected Individuals Code, mainly MCL 700.5506 through 700.5515.
Who can make one and who can serve
An adult 18 or older who is of sound mind can sign a patient advocate designation naming another adult, 18 or older, as patient advocate (MCL 700.5506). You can also name a successor to step in if your first choice doesn't accept, becomes incapacitated, resigns, or is removed (MCL 700.5507).
The document can include your wishes about care, custody, and medical or mental health treatment, instructions for your advocate, and organ donation choices.
Signing requirements and who can witness
Under MCL 700.5506, the designation must be in writing, signed, dated, executed voluntarily, and signed in the presence of two witnesses who also sign. Michigan law bars a long list of people from serving as a witness:
- Your spouse, parent, child, grandchild, or sibling
- Your presumptive heir or a known beneficiary of your will
- Your physician
- Your patient advocate
- An employee of your life or health insurer, of a health facility treating you, of a home for the aged where you live, or of a community mental health program or hospital providing mental health services to you
Witnesses shouldn't sign unless you appear to be of sound mind and free from duress, fraud, or undue influence. The statute doesn't call for a notary.
The designation must also be made part of your medical record before anyone relies on it, and it must state that the authority can be used only when you're unable to participate in your own medical or mental health treatment decisions.
The patient advocate acceptance
Before acting, your patient advocate must receive a copy of the designation and sign an acceptance (MCL 700.5507). The acceptance must include substantially the statements listed in the statute. These cover points like:
- The designation only works when you can't participate in the decision.
- The advocate can't make choices you couldn't have made for yourself.
- The advocate must act as a fiduciary and in your best interests.
- The advocate can't be paid, though reasonable expenses may be reimbursed.
- You can revoke the designation at any time.
The acceptance can be signed at the same time or later.
When a patient advocate can start making decisions
Under MCL 700.5508, a patient advocate can act only when you're unable to participate in medical treatment decisions. Your attending physician and another physician or licensed psychologist must examine you and put that determination in writing in your medical record. It must be reviewed at least once a year.
If you regain the ability to participate, the patient advocate's authority is suspended (MCL 700.5509). If there's a dispute about whether you can participate, a petition can be filed asking the probate court to decide.
Life-sustaining treatment decisions
A patient advocate may decide to withhold or withdraw treatment that would allow you to die only if you expressed, in a clear and convincing manner, that the advocate is authorized to make that decision, and that you understand it could or would allow your death (MCL 700.5509(1)(e)). That's why the wording in this part of the document matters.
Michigan law also says a patient advocate can't make a decision to withhold or withdraw treatment from a pregnant patient that would result in the patient's death. And if the advocate knows you currently want specific life-extending care, that wish is binding, whatever your condition at the time (MCL 700.5511).
Mental health treatment decisions
Michigan treats mental health decisions separately. A patient advocate can make mental health treatment decisions only after a physician and a mental health practitioner both certify in writing, after examining you, that you can't give informed consent (MCL 700.5515).
Consent to forced medication, or to inpatient hospitalization other than as a formal voluntary patient, requires your clear and convincing authorization in the document (MCL 700.5509). You may also choose to waive your right to revoke for mental health decisions. If you do, treatment can continue for up to 30 days after you say you want to revoke.
Changing or revoking
You can generally revoke a patient advocate designation at any time and in any way that communicates your intent, even if you've been found unable to participate in decisions (subject to a mental health waiver). If you named your spouse, the designation is suspended during a divorce, annulment, or separate maintenance case and revoked when the judgment enters, unless you named a successor (MCL 700.5510).
How it fits with other documents
A patient advocate designation is separate from a durable power of attorney for finances. Since July 1, 2024, Michigan financial powers of attorney fall under the Uniform Power of Attorney Act (MCL 556.201 and following), which doesn't apply to patient advocate designations. A HIPAA authorization can let named people receive your health information. A living will records your wishes.
When to talk with a Michigan attorney
Consider a licensed Michigan attorney if there's a question about your capacity, family members disagree about your care, you have complex mental health treatment wishes, or you spend significant time in another state.
Michigan patient advocate templates
Our Michigan Patient Advocate Designation Template is a self-help Word and PDF template. The Michigan Healthcare Documents Trio pairs it with a living will and HIPAA authorization. Browse more Michigan legal document kits.
Disclosure: Rexford Mercantile is not a law firm and is not a substitute for a lawyer. This article is general information, not legal advice, and it may not reflect the most recent changes in Michigan law. We sell self-help document templates. For advice about your situation, talk with a licensed Michigan attorney.