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Advance Directives, DNRs, and Other Legal Documents

Advice and Tips on Aging WellCaregiver

A Guide to Some Must-Have, End-of-Life Legal Documents

Most of us are too busy living to prepare for dying. And who really wants to think about what might happen if we are severely injured in an accident or we have a stroke?

But having a plan in writing can reduce anxiety about the future. If you have children, they will be relieved to not have to make tough decisions about your health care.

There are legally binding forms you can use on your own to appoint a person to make healthcare decisions for you if you can’t. You can even appoint a second person in case the first advocate is unable to carry out your wishes.

Here is a list of the documents you may want to have in order:

Advance Directive

There are two kinds of advance directives: a durable power of attorney for health care and a do not resuscitate (DNR) order. Both state the kind of medical intervention you want in the event that you are unable to make a medical decision on your own. Both require signatures and two adult witnesses (not a spouse or blood relative) to be legally binding.

If you don’t have an advance directive, the health care provider may take direction from your spouse or another family member as to treatment. In a worst-case scenario, the probate court would need to get involved in appointing a guardian.

Durable Power of Attorney for Health Care

This is the adult you appoint to serve as your patient advocate, who can be your child, spouse or friend. The advocate has the duty to make treatment and personal care decisions based on your wishes for medical intervention. It is used in an inpatient healthcare setting such as a hospital.

Your patient advocate can:

  • Consent to or refuse medical treatment for you
  • Arrange for mental health treatment, aides in the home, or adult day care
  • Admit you to a hospital, nursing home or home for the aged (unless you specify that you want to remain in your home)
  • Decide to withhold or withdraw food and water if you are being tube fed (with your prior authorization)
  • Instruct hospital not to use a ventilator to keep you breathing (with your prior authorization)
  • Make a gift of your organs or body to science, effective upon death (with your prior authorization; see ‘Declaration of Anatomical Gift’ below); you can also specify your wishes concerning your body on your driver’s license.

If your religious beliefs prohibit an examination by a doctor or autopsy, note that in your advance directive.

Once you’ve designated an advocate and signed forms, give the originals to your advocate and a copy to your healthcare provider. Ask that it be part of your medical record.  Make sure you have a copy of your advance directive.

You can change your advance directive and designate a new patient advocate any time. Make sure your patient advocate has an original and a copy is given to your healthcare provider.

If you don’t hire an attorney to draft the necessary form designating a patient advocate, you may use a form found online or write out one yourself. Any form must be witnessed by two adults and signed by the patient advocate. Witnesses cannot be a spouse, blood relative, a known beneficiary, your doctor, health insurance provider, or anyone in a medical facility where you might be receiving medical or mental health services.

Do-Not-Resuscitate Order

The DNR is a document that states that you do not wish to be resuscitated in case your heart or breathing stops. The order is intended for non-healthcare settings such as your home and should be kept in a spot where emergency medical personnel and/or your family can find it. It is also a good idea to have one if you are a hospice patient who wants to die as peacefully as possible.

The DNR order or declaration is legally binding in Michigan, in settings other than a hospital or nursing home, which can set their own policies about resuscitation. If you are admitted to a hospital or nursing home, you or your patient advocate should ask that the DNR order or wishes not to be resuscitated be placed in your medical chart. Your advance directive may also include a wish not to be resuscitated.

There is a form for your doctor, you, and two witnesses to sign in order for the DNR order to be legally valid.

Declaration of Anatomical Gift

This is a form you use to declare that you want your entire body or certain parts of your body donated to science after your death. It is a good idea to keep this with your advance directive and to let your patient advocate know your wishes.

Living Will

This is a document in which you state the kind of medical care you would like to receive if you become terminally ill or permanently unconscious and are unable to make health care decisions for yourself.  Unlike an advance directive, the document is NOT legally binding in Michigan. However, it may help your patient advocate to better understand your treatment choices.

A living will:

  • Might state what kind of treatment, if any, you want (CPR, surgery, blood transfusions, experimental treatment)
  • Should express your wishes concerning food and water administered through tubes

It’s smart to have a living will if you haven’t designated a durable power of attorney for health care. But having both isn’t a bad idea.

Because there is no state law guiding requirements of a living will, you may create a document that is dated, signed by you, and signed by two witnesses who are not family members.

Keep a copy of the living will for your records and make copies for family, friends and your health care provider.

Other Resources

Peace of Mind booklet published by the Michigan Legislature has detailed information lets you create a record of important documents.

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