Durable Power Of Attorney For Health Care (Page 11 of 15) in pdf

V. Acceptance to the Designation of Power of Attorney

hereby accept the

(Print patient advocate’s name)

Responsibilities conferred upon me by

(Print principal’s name)

to serve as patient advocate in the durable power of attorney document executed on

. I maintain the right to revoke this acceptance at

(Date)

any time, and by any means whereby I may communicate a desire to revoke it. By providing my signature

below I acknowledge that I have read and understand the requirements of Michigan law pertaining to the

execution of a durable power of attorney for health care, set out in sections (A) through (I) below.

(A) This designation is not effective unless the patient is unable to participate in medical treatment

decisions.

(B) A patient advocate shall not exercise powers concerning the patient’s care, custody, and medical

treatment that the patient, if the patient were able to participate in the decision, could not have

exercise on his or her own behalf.

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 that would allow a patient

to die only 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, rights, 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 treatment decisions are

presumed to be in the patient’s best interests.

(G) A patient may revoke his or her designation at any time and in any manner sufficient to communicate

an intent to revoke.

(H) A patient advocate may revoke his or her acceptance to the designation at any time and in any manner

sufficient to communicate an intent to revoke.

Durable Power Of Attorney For Health Care Page 11