Michigan Advance Directive: Types, Patient Advocate Rules, and Forms

A Michigan advance directive is a written document that lets you name someone to make medical decisions for you if you lose the ability to make them yourself, and the state’s main form for doing that is called a Patient Advocate Designation. It is governed by Michigan Compiled Laws 700.5506 through 700.5515 and can cover physical health, mental health treatment, and end-of-life care. You need to put it in place while you are healthy and of sound mind; once a crisis hits, the chance to sign one is gone.

What Counts as an Advance Directive in Michigan

Patient Advocate Designation

The Patient Advocate Designation is the core document. Under MCL 700.5506, any adult of sound mind can name another adult to make care, custody, and medical or mental health treatment decisions on their behalf if they become unable to participate in those decisions.¹ The designation only activates when you can no longer speak for yourself, so signing it does not transfer any authority while you are still capable.

Living Wills

Michigan has no statute that makes a stand-alone living will legally binding. Its weight comes from common law rather than any legislative provision.² A written statement of your preferences can still be used as evidence of your wishes, especially if your Patient Advocate Designation does not address a particular issue.³ The practical move is to fold any living-will language directly into your Patient Advocate Designation rather than keeping a separate document.

Out-of-Hospital Do-Not-Resuscitate Order

Michigan also recognizes an Out-of-Hospital Do-Not-Resuscitate order under the Do-Not-Resuscitate Procedure Act. It is narrower than a Patient Advocate Designation: it tells emergency responders not to perform CPR, defibrillation, intubation, or other resuscitation if your heart and breathing stop outside a hospital.⁴ It must be signed by you (or your patient advocate), your attending physician, and two witnesses, at least one of whom is not a close family member or presumptive heir. Many people have both documents.

How to Create a Valid Patient Advocate Designation

Who Can Sign and Who Can Serve

You and the person you name must each be at least 18, and you must be of sound mind when you sign.¹ Your advocate does not need to be a Michigan resident or have medical training. Name at least one successor in case your first choice is unavailable or unwilling when the time comes.

Witness Restrictions

Two adults must witness your signature, and the law disqualifies anyone with a conflict of interest. Under MCL 700.5506, these people cannot serve as witnesses:

Your spouse, parent, child, grandchild, or sibling.
Any presumptive heir or anyone known to be named in your will or other estate plan.
Your physician, any employee of the facility treating you, or an employee of your health or life insurance provider.
Your patient advocate.

Each witness must confirm that you appear to be of sound mind and are not acting under duress, fraud, or undue influence.¹ Coworkers, friends, and neighbors who meet the age requirement and have no disqualifying tie are usually the simplest choices.

Notarization

The state does not require notarization. Two valid witness signatures make the document legally sufficient. Some estate planning attorneys still suggest notarizing it as an extra layer of verification against later challenges.

Your Advocate Must Accept in Writing

Naming an advocate is not enough on its own. Before the advocate can act, they must sign a written acceptance of the role, and they must receive a copy of the designation. The same applies to any successor before the successor acts.⁵ If the acceptance is not signed before a medical crisis, providers may refuse to recognize the advocate.

What Authority You Can Grant

You decide how broad or narrow the designation is, but certain powers only exist if the form says so.

End-of-Life Decisions

An advocate may authorize withholding or withdrawing treatment that would allow you to die only if you have expressed that authority in a clear and convincing manner in the written designation, and you must acknowledge that such a decision could or would result in your death.⁵ This usually appears as a specific checkbox or signature line on the form. Without it, providers are generally obligated to continue treatment regardless of what your advocate says. The treatments at stake include mechanical ventilation, CPR, and artificial nutrition and hydration.

One hard limit: an advocate cannot direct the withdrawal of treatment from a pregnant patient if doing so would result in her death.⁵

Mental Health Treatment

The statute lets you extend the advocate’s authority to mental health treatment decisions. If you include mental health provisions, the designation must be placed in your medical record with the mental health professional or community mental health program providing your treatment before the advocate can act on those issues.¹ Specificity helps. Spell out your preferences on psychiatric medications, inpatient commitment, or electroconvulsive therapy so your advocate is not guessing.

Other Preferences

You can also include instructions on organ donation, pain management, experimental treatments, and religious or spiritual considerations. Concrete instructions leave less room for family disagreement or provider hesitation. The advocate’s role is to carry out your known wishes, not to improvise.

When the Designation Actually Takes Effect

Signing the form hands over nothing. The designation lies dormant until a formal incapacity determination triggers it under MCL 700.5508.

Two professionals must examine you and agree that you are unable to participate in medical treatment decisions: your attending physician plus either a second physician or a licensed psychologist. Their determination must be documented in writing and placed in your medical record, and it must be reviewed at least once a year so the advocate’s authority can be reconsidered if your condition improves.⁶

If someone disputes whether you are truly incapacitated, they can petition the probate court in the county where you live or are located, and the court will appoint a guardian ad litem and hold a hearing on an expedited schedule.⁶ If religious beliefs prevent you from being medically examined, you can specify an alternative method for determining your capacity in the designation itself.

Changing or Revoking Your Designation

You can revoke a Patient Advocate Designation at any time, in any way you can communicate the intent to revoke, even after you have already been found unable to participate in treatment decisions. A spoken statement, a gesture, or any other form of communication is enough.⁷

If the revocation is not in writing, whoever witnesses it must document the circumstances in writing, sign that description, and notify the patient advocate if possible. Any physician, mental health professional, or facility that learns of the revocation must note it in your records and bedside chart and notify the advocate.

A few events revoke the designation automatically:

Signing a later Patient Advocate Designation that expressly revokes the earlier one or is inconsistent with it.
A revocation clause built into the original designation that is triggered by specific conditions.
Entry of a judgment of divorce, annulment, or separate maintenance when your advocate is your spouse, unless the document names a successor.

The divorce rule catches people off guard. If you are separating from a spouse who is your designated advocate, deal with the document immediately rather than assuming the old form still works.⁷

To update rather than revoke, the cleanest path is to execute a new designation that expressly supersedes the old one. The new form has to meet all the same signing and witnessing requirements.¹

Where to Get a Form and How to Store It

The Michigan Legislature publishes a free guide called Peace of Mind that includes a blank Patient Advocate Designation form meeting the statutory requirements.⁸ You do not need an attorney to complete it, though legal help is useful for blended families, complex medical conditions, or carefully drafted mental health provisions.

A signed designation locked in a safe deposit box is close to useless in an emergency. Distribute copies to the people and places most likely to need them:

Your primary care physician, so it gets scanned into your electronic health record.
Local hospitals, especially any facility where you are likely to receive emergency care.
Your patient advocate and successor advocate, who each need their own copy and should know where the original is kept.
Close family members, which reduces disputes during a crisis.

Keep the original somewhere secure but quick to reach, like a home desk drawer or filing cabinet. A wallet card identifying your patient advocate and noting that a designation exists can tip off emergency responders before they ever reach your medical records. Michigan has also offered a Peace of Mind Registry through the Department of Health and Human Services as an electronic storage option; if it is available and accepting submissions, uploading your designation gives providers another way to find it. Physical distribution to your medical team and advocate is still the most reliable safeguard.

1
Michigan Legislature. Michigan Compiled Laws 700.5506 – Designation of Patient Advocate
2
Michigan State Law Review. Advance Care Planning During COVID and the Future of Will Formalities in Michigan
3
Michigan Legal Help. What Is an Advance Directive?
4
Michigan Legislature. Michigan Do-Not-Resuscitate Procedure Act
5
Michigan Legislature. Michigan Compiled Laws 700.5507 – Patient Advocate Designation; Statement; Acceptance
6
Michigan Legislature. Michigan Compiled Laws 700.5508 – Determination of Advocate’s Authority to Act
7
Michigan Legislature. Michigan Compiled Laws 700.5510 – Revocation of Patient Advocate Designation
8
Michigan Legislature. Peace of Mind – A Guide to Medical and Legal Decisions