Advance Care Planning: Michigan Healthcare Directives
Advance care planning involves making decisions regarding your future healthcare in case you become incapacitated and unable to speak for yourself. Many people believe healthcare directives only apply to the elderly; however, this is not the case.
Anyone may have a serious accident, suffer a stroke, or slip into a coma as a result of an illness or head injury. When these devastating situations occur family members are fragile and upset. Consequently, it’s not the optimal time to make life/death decisions and the patient is unable to express their wishes. So, advance care planning helps the family and the patient.
Types of Medical Decisions
Healthcare decisions depend on various factors including age, health status, and personal preference. A healthy 40 year old having surgery would want life saving measures if complications arose during an operation. On the other hand, a 40 year old accident victim with no brain activity may not want to be kept alive for decades on a ventilator. The following are some medical interventions that may be part of advance care planning:
- Tube feeding
- Artificial hydration
- DNR order- Do Not Resuscitate
- Comfort care
- Organ donation
Michigan Advance Care Planning
In Michigan, there are many laws that protect patients. Doctors must follow a patient’s wishes unless the patient is declared incompetent. Of course, parents have the right to recommend care for children under the age of 16.
Some people have a “living will.” In Michigan, this document alone is insufficient for medical purposes. It’s important to speak to an estate planning attorney to see which other legal documents are necessary to enforce your wishes. Sometimes a Durable Healthcare Power of Attorney is combined with the living will. Of course, your lawyer should examine these documents.
Patient Advocate Designation – Overview
The Michigan Patient Advocate Designation lets you name someone to make decisions about your medical care — including decisions about life support, mental health treatment and anatomical gifts — if you can no longer speak for yourself. The patient advocate designation is especially useful because it appoints someone to speak for you any time you are unable to make your own health care treatment decisions, not only at the end of life.
Your patient advocate’s powers go into effect when your doctor determines that you are no longer able to make or communicate your health care decisions.
Your patient advocate may be a family member or a close friend whom you trust to make serious decisions. The person you name as your patient advocate should clearly understand your wishes and be willing to accept the responsibility of making health care decisions for you.
You can appoint a second person as your alternate patient advocate. The alternate will step in if the first person you name as a patient advocate is unable, unwilling, or unavailable to act for you.
Patient Advocate Designation – Legal Process
As discussed, the Patient Advocate Designation Form designates who will speak for you regarding healthcare decisions. This legal document must be properly signed and accepted by the person you choose to represent you. Make sure this individual is someone you trust and someone who can handle this responsibility.
Generally, a patient advocate is a family member or a very close personal friend. Some folks choose two advocates in case the first one is unavailable. Also, it’s important to review this document over the years. Sometimes, one’s health situation may have changed, or a patient advocate may have moved away. So, every few years meet with your attorney to ensure your documents are current.
For mentally healthy adults, the Michigan Patient Advocate Designation Form allows you to name the person, or persons that will make medical decisions for you if necessary. An experienced elder care attorney can assist you with filling out this form and getting it properly notarized.
It’s important to note that any legal form must be properly witnessed. In Michigan, The Patient Advocate Designation Form requires 2 witnesses. The signatories may NOT be the following:
- Your spouse, child, brother, sister, grandchild
- A person who stands to inherit from your estate
- An employee of a facility where you are living
- Anyone from your life insurance company
- Your physician or patient advocate, an employee of a health care or mental health care facility where you are being treated
- An employee of a home for the aged, if you are a patient in that facility.
Your patient advocate designation form will be valid after you and your witnesses sign it. However, your patient advocate and alternate (if any) must receive a copy of your document and date and sign an acceptance of his or her responsibilities before making any decisions on your behalf. An acceptance form is included as pages 5 and 6 of the Michigan Advance Directive, in the event you want to obtain your advocate’s acceptance now.
Divorce and Patient Advocates
The various areas of law often intersect in ways you wouldn’t imagine. Visualize this scenario, you filed for divorce from your spouse of seven years. While the case is still pending you are admitted to the hospital for surgery. Now imagine something goes wrong during surgery and the hospital contacts your spouse, who is not yet your ex-spouse, to ask how they should proceed or to approve a possibly risky surgical procedure. Would you want your ex-husband or wife making medically decisions on your behalf? This may sound like a nightmare ripped from the daytime television shows, but this exact situation has crossed my desk.
No one should ever step foot into a hospital or plan a surgical procedure without first seeking out an experienced probate attorney to assist in drafting a patient advocate designation. Not all trips to the hospital are planned, meaning the longer you wait the greater the risk you will be unprepared or even unable to choose who should make dire medical decisions on your behalf. Those who are thinking about filing, have just filed, or just completed a divorce need to plan ahead and make sure they designate the right person to make medical decisions for them.
Types of Advance Directives
Michigan has two kinds of Advance Directives. One is the Durable Power of Attorney for Healthcare (DPOA-HC), which can be used in both inpatient and ambulatory care settings within the University of Michigan Hospitals and Health Centers.
The other is a Do-Not-Resuscitate (DNR) Declaration, which is for non-hospital settings. If either of these legal documents is missing certain elements, they may not be valid; however, the information in them could be used to show a patient’s intent or wishes regarding treatment choices.
A Living Will is not recognized as a legally binding Advance Directive in Michigan. However, a Living Will is sometimes combined with a valid Durable Power of Attorney for Health Care to help the Patient Advocate named in the DPOA-HC to understand the patient’s treatment choices.