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CONDITIONS
UNDER WHICH YOU MAY EXECUTE A LIVING WILL
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 If at any time you should have
an incurable condition certified in
writing by your attending physician and one other qualified physician to be terminal or you have been unconscious, comatose, or otherwise incompetent so as to
be unable to make or communicate responsible decisions concerning your
person, you may direct that such procedures which
would only prolong the dying process be withheld or withdrawn, and that
you be permitted to die naturally with only the administration of
medication to provide you comfort care.
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ADDITIONAL INFORMATION ABOUT THIS LIVING WILL
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Designation of Agent
This living will gives you the option to designate a proxy
(agent), who may in consultation with your attending physician,
make health care decisions according to your wishes when you are in a
terminal condition and cannot do so. Your proxy as the same right as you
have to examine your medical records and to consent to their disclosure
for purposes related to your health care or insurance unless you limit
this right in this document.
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Election of Treatment(s)
Among those are matters which relate to treatment
while you are permanently unconscious and the condition is irreversible.
You will be given the option of receiving artificial nutrition and
hydration and other treatment. However, if you should desire any
other treatment you can write your own
directives. If you feel you may want to write additional directives,
you should discuss this with your physician before purchasing this form.
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Anatomical Gifts
This directive allows you
to donate organs and/or tissues for transplantation once you have been
declared dead. If you elect to donate organs and/or tissues for
transplantation, you may be maintained on artificial support systems
only for the period of time required to maintain the viability of and
to remove such organs and/or tissues.
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Operative Date
Your living will becomes operative when a copy is provided to
your attending physician; and you are determined by
your attending physician to be incompetent and in a terminal condition or
in a state of permanent unconsciousness.
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Duty of Attending
Physician(s)
When your living will becomes
operative, your physician and other health care providers shall act in
accordance with its provisions. If your attending physician or other
health care provider cannot in good conscience comply with the provisions
of your living will or if the policies of the health care provider
preclude compliance, your attending physician or health care provider
shall so inform you, or, if you are incompetent, shall so inform your
agent, or, if you have not designated a health care proxy, shall so inform
your family, guardian or other representative. Your physician and
health care provider shall make every reasonable effort to assist in the
your transfer to another physician or health care provider who will comply
with your living will.
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Revocation
Your living will may be
revoked at any time and in any manner by you without regard to your
mental or physical condition. A revocation is effective upon
communication to your attending physician or other health care
provider by you or a witness to the revocation.
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Ancillary Effect of
Executing Living Will
Death resulting from the withholding or withdrawal of life-sustaining
treatment does not constitute, for any purpose, a suicide or homicide.
The making of a declaration does not affect in any manner the sale,
procurement, or issuance of any policy of life insurance, nor does it
modify the terms of an existing policy of life insurance. A policy
of life insurance is not legally impaired or invalidated in any manner by
the withholding or withdrawal of life sustaining procedures from an
insured qualified patient, notwithstanding any term of the policy to the contrary.
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 Executing and Delivering Your Living Will
After you have printed your advance directive, you must sign in front of a notary
public OR or sign before two witnesses (over
18). If you sign before witnesses, please note the qualifications of
the witnesses contained in the witness statement. A fully executed original or copy should be submitted to your
physician for entry in your medical records. Copies may be made and
given to trusted family members.
(If you want to designate a Patient Advocate
as authorized by Michigan Compiled Laws §700.5507
click here. A Patient Advocate allows
you to designate an agent to make ALL health care decisions for you,
including life sustaining procedures, when you are unable to make them for
yourself.) |
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