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 An individual 18 years of
age or older who is of sound mind at the time the designation is made may
designate in writing another individual who is 18 years of age or older to
exercise powers concerning care, custody, and medical treatment decisions
for the individual making the designation. For purposes of this
section, an individual who is named in a designation to exercise powers
concerning care, custody, and medical treatment decisions is known as a
patient advocate and an individual who makes a designation is known as a
patient.
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ADDITIONAL INFORMATION ABOUT THIS POWER OF ATTORNEY |
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Designation of Agent
You may designate an patient advocate
(agent) to make
health care decisions for you when you are no longer capable of making
them yourself. Your agent may consent, refuse to consent, or
withdraw consent to medical treatment and may make decisions about
withdrawing or withholding life-sustaining treatment. The authority
granted your agent will only become exercisable when you are unable to
participate in medical treatment decisions.
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Withholding or Withdrawal of Artificial Nutrition and Fluids
If you want to give your agent
authority to withhold or withdraw the artificial providing of nutrition
and fluids, your document should say so. Otherwise, your agent will
not be able to direct that unless you have otherwise indicated this
desire to him or her.
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Revocation
You have the
right to revoke the authority granted to your agent by informing him or
her or your health care provider orally or in writing.
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Reservation of Rights
Notwithstanding the above, this
designation of patient advocate reserves you the right to make health care decisions for
yourself as long as you are able to give informed consent with respect
to a particular decision. In addition, no treatment may be give to
you over your objection.
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Executing and Delivering Your Power of Attorney
Before this designation
is implemented, it must be made a part of your medical records with your
attending physician. Therefore, after this document is completed
and executed it must be delivered to your attending physician. In
the alternative, it must be delivered to your patient advocate with
instructions for him or her to deliver it to your attending physician in
the event you become unable to participate in your medical treatment
decisions.
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Effect of Guardianship
If you are legally
incapacitated and have a guardian with responsibility for making medical
treatment decisions you may not designate an advocate using this form.
This Designation of Patient Advocate consists
of approximately four pages.
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SOURCE: Chapter 700.5506 and
700.5507 of the Michigan Compiled Laws.
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This
power of attorney may be a general or
limited
power of attorney. For example, you may empower your agent to do any act
which you could do yourself (general power of attorney) or limit your
agent's authority to a specific transaction (limited power of attorney).
Options in this form include appointing an agent to dispose of
your property, collect your debts, endorse your checks, execute government
vouchers, deposit money or other property, borrow money, acquire property,
recover possession of property, institute or defend lawsuits, prepare and
file tax returns, transfer title to automobiles and perform any act which
you may do yourself.
This is a durable power of attorney meaning it is not affected by your
subsequent disability or incompetence.