Durable Power Of Attorney For Healthcare (Page 6 of 8) in pdf

5. Acceptance of Patient Advocate

The Patient Advocate and any successor Patient Advocate must sign this Acceptance before he/she may act

as Patient Advocate.

I agree to be the Patient Advocate for _______________________________ (called “Patient” in this document).

I accept the Patient’s designation of me as Patient Advocate. I understand and agree to take reasonable steps

to follow the desires and instructions of the Patient as indicated in the Designation of Patient Advocate, in

other written instructions of the Patient and as we have discussed verbally.

I also understand and agree that:

a. This designation shall not become effective unless the Patient is unable to participate in medical

treatment decisions or give informed consent to mental health treatment.

b. A Patient Advocate shall not exercise powers concerning the patient’s care, custody, and medical

and/or mental health treatment that the Patient, if the Patient were able to participate in the

decision, could not have exercised on his or her own behalf.

c. This designation cannot be used to make a medical treatment decision to withhold or withdraw

treatment from a Patient who is pregnant that would result in the pregnant Patient’s death.

d. A Patient Advocate may make a decision to withhold or withdraw treatment which would allow a

Patient to die if the patient has expressed in a clear and convincing manner that the Patient

Advocate is authorized to make such a decision, and that the Patient acknowledges that such a

decision could or would allow the Patient’s death.

e. A Patient Advocate shall not receive compensation for the performance of his or her authority,

rights and responsibilities, but a Patient Advocate may be reimbursed for actual and necessary

expenses incurred in the performance of his or her authority, right and responsibilities.

f. A Patient Advocate shall act in accordance with the standards of care applicable to fiduciaries

when acting for the Patient and shall act consistent with the Patient’s best interests. The known

desires of the Patient expressed or evidenced while the Patient is able to participate in medical

and/or mental health treatment decisions are presumed to be in the Patient’s best interest.

g. A Patient may revoke his or her designation at any time and in any manner sufficient to

communicate intent to revoke.

h. A patient may waive his or her right to revoke the designation as to the power to make mental

health treatment decisions and, if such a waiver is made, his or her ability to revoke as to certain

treatment will be delayed for up to 30 days.

i. A Patient Advocate may revoke his or her acceptance to the designation at any time and any

manner sufficient to communicate intent to revoke.

j. A Patient admitted to a health facility or agency has the rights enumerated in Section 20201 of the

Public Health Code, Act No.368 of the Public Acts of 1978, being Section 333.20201 of the

Michigan Compiled Laws.

k. If the designation authorizes the Patient Advocate to make an anatomical gift, the authority

remains exercisable after the Patient’s death. A Patient Advocate may not exercise the authority to

make an anatomical gift if the Patient Advocate has received actual notice that the Patient

expressed an unwillingness to make the gift.

Durable Power Of Attorney For Healthcare Page 6