How to Fill Out a Michigan Advance Directive Form: Patient Advocate

To fill out a Michigan advance directive form, complete a Patient Advocate Designation under MCL 700.5506: name someone you trust as your patient advocate, write out the medical treatments you do and don’t want (including explicit end-of-life language if you want your advocate to be able to refuse life support), sign and date the form in front of two qualified witnesses, have your advocate sign a written acceptance of the role, and file copies with your doctor and hospital.¹ Michigan has no separate living-will statute and no mandatory state form, so any end-of-life instructions go directly into the designation itself. You can use the sample form published by the Michigan Legislature, a form from your hospital or a legal aid organization, or one drafted by an attorney.²

Step 1: Name Your Patient Advocate and a Successor

Your advocate must be at least 18 and of sound mind.¹ Beyond that, pick someone who understands your values about medical care and can hold firm against pressure from doctors or other family members. The form asks for the advocate’s full name, address, and phone number so hospital staff can reach them in an emergency.

Name at least one successor advocate too. A successor only has authority once they receive a copy of the designation and sign their own acceptance, so make sure anyone you name as backup knows about it in advance.³

One practical point to raise with whoever you ask: your advocate cannot be paid for the role. Michigan law allows reimbursement for actual out-of-pocket expenses such as travel, copying, and hospital parking, but not a fee for the advocacy itself.³

Step 2: Spell Out the Treatment Decisions You Want Covered

The designation lets you record exactly what you want and don’t want. You are not limited to checking boxes; you can write out detailed personal instructions. The more specific you are, the less your advocate has to guess under pressure.

End-of-Life Authority

If you want your advocate to be able to refuse life-sustaining treatment on your behalf, including ventilators, feeding tubes, and IV fluids, you have to say so in language the law considers “clear and convincing.” Most forms handle this with a specific paragraph you initial or sign, stating that you authorize your advocate to make decisions that could allow your death and that you understand the consequences.²

Without that explicit language, your advocate legally cannot authorize withdrawing treatment that would let you die, no matter what they believe you would have wanted. This is where many designations fall short. People name an advocate but never grant the end-of-life authority, leaving the advocate powerless in exactly the situation the form was designed for.

You can also set conditions. For example, you might authorize withdrawing life support only if you are in a persistent vegetative state or have a terminal diagnosis with no reasonable chance of recovery, while requesting full treatment in all other situations.

Mental Health Treatment

Michigan lets you extend your advocate’s authority to mental health decisions, including inpatient psychiatric hospitalization and medication choices. If you include mental health authority, there is one unusual wrinkle: you can waive your right to immediately revoke the designation as it relates to mental health treatment. If you include that waiver, any attempt to revoke mental health authority is delayed by 30 days.³ The waiver exists because some psychiatric conditions can cause a patient to resist treatment they, when stable, wanted to continue. Without the waiver, you can revoke mental health authority instantly like any other part of the designation.

Organ and Tissue Donation

You can authorize your advocate to make an anatomical gift of all or part of your body for transplantation or research. If you include this authority, the designation must state that the organ-donation power remains in effect after your death, a detail standard forms typically include as a preprinted statement.¹

Step 3: Sign in Front of Two Qualified Witnesses

You must sign and date the designation in front of two witnesses. Michigan does not require notarization. Two qualified witnesses are enough to make the document legally valid.¹ The witnesses sign the form, print their names, and provide their addresses. Each witness must also attest that you appeared to be of sound mind and were not acting under pressure.

The list of people who cannot serve as witnesses is longer than most people expect. None of the following may witness your signature:

Your spouse, parent, child, grandchild, or sibling
Your presumptive heir or anyone named as a beneficiary in your will
Your physician
The person you are naming as your patient advocate
Any employee of your life or health insurance company
Any employee of a health facility currently treating you, a nursing home where you live, or a community mental health program serving you

That rules out most of the obvious choices. Good options are friends, neighbors, coworkers, or members of your faith community who have no financial or familial stake in your care. If you are physically unable to sign, someone else may sign at your direction and in your presence, as long as both witnesses observe the entire process.¹

Step 4: Have Your Advocate Sign the Written Acceptance

This is the step most people overlook, and skipping it makes the entire designation unenforceable. Before your advocate can act on your behalf, they must sign a written acceptance of the appointment.³ The acceptance must include ten specific acknowledgments spelled out in MCL 700.5507(5). Most standard forms print these statements directly on the form so the advocate can read and sign them in one step. The key acknowledgments cover:

Activation standard: the designation only takes effect when you are unable to participate in your own medical or mental health decisions.
Scope limits: the advocate cannot authorize anything you couldn’t have authorized for yourself.
Pregnancy restriction: the advocate cannot withhold or withdraw treatment from a pregnant patient if doing so would result in the patient’s death.
End-of-life authority: the advocate may only make a decision to withhold or withdraw treatment that would allow you to die if you expressed that authority in a clear and convincing manner and acknowledged it could lead to your death.
No compensation, but reimbursement of actual expenses is allowed.
Best-interests duty: the advocate must act as a fiduciary and follow your known wishes.
Revocability: you can revoke the designation at any time, and the advocate can resign at any time.

Hand or mail a copy of the completed designation to your advocate before any emergency arises. If a successor ever steps in, they need their own copy and must sign their own acceptance before they have any authority.³

Step 5: File Copies With Your Doctors and Store the Original

Before the designation can be used, it must become part of your medical record with your attending physician or the facility providing your care.¹ This is a legal requirement, not just a good idea. Distribute copies to:

Your primary care physician’s office, with a request to scan it into your electronic health record
Your patient advocate and any named successors
Any hospital or specialist where you receive regular treatment

Keep the original somewhere your family can find it quickly: a home safe someone else can open, a labeled folder in a desk, or with your other estate-planning documents. A fireproof lockbox only you can access defeats the purpose. Some people also carry a wallet card noting that they have a patient advocate designation and listing the advocate’s contact information.

Changing or Revoking the Designation Later

You can revoke your patient advocate designation at any time and in any way that communicates your intent: verbally, in writing, or by destroying the document. You do not need to be mentally competent to revoke. Even if you’ve been determined unable to make medical decisions, you can still revoke the designation if you can communicate that intent.⁴

If your revocation is not in writing, anyone who witnesses it must describe the circumstances in writing, sign that description, and notify your advocate. Your physician or health facility must also note the revocation in your medical record and bedside chart and inform the advocate.⁴

To change advocates rather than revoke entirely, execute a new designation with a new date. The most recent valid designation controls, but notify your providers to swap the old version out of your records so there is no confusion. The one exception to instant revocability is the mental health waiver described earlier, which delays revocation by 30 days.

What the Patient Advocate Designation Doesn’t Do

The designation tells your advocate what you want, but it is not an order EMS crews can act on at your front door. For out-of-hospital emergencies, Michigan uses a separate document, the Michigan Physician Orders for Scope of Treatment (MI-POST), which translates your wishes into a medical order paramedics follow for decisions like CPR, intubation, and transport. The MI-POST is designed for adults with advanced illness or frailty where death is expected within a year, and it must be signed by you (or your patient advocate if you lack capacity) and by your physician, nurse practitioner, or physician assistant. It does not require witnesses, but it must be reaffirmed every year and whenever your level of care changes.⁵ If you are seriously ill and want paramedics to honor your treatment limits, you need both documents.

1
Michigan Legislature. Michigan Code 700.5506 – Designation of Patient Advocate
2
Michigan Legislature. Planning on Your Peace of Mind
3
Michigan Legislature. Michigan Code 700.5507 – Patient Advocate Designation Statement and Acceptance
4
Michigan Legislature. Michigan Code 700.5510 – Patient Advocate Designation Termination
5
Michigan Department of Health and Human Services. MI-POST Frequently Asked Questions