Durable Power Of Attorney For Health Care (Page 5 of 15) in pdf

Guide for Using the Durable Power of Attorney Form

The pages following this guide contain a blank copy of a Durable Power of Attorney for Health Care

form which you may use to designate your patient advocate. This is a suggested form only.

Michigan law does not require a specific form to be used. If you wish to provide more details in

your durable power document; you may attach additional pages to it containing those details. This guide

is intended to help clarify the purposes of the various provisions in this form.

THIS FORM PROVIDES FOR A DURABLE POWER OF ATTORNEY FOR PURPOSES OF CARE,

CUSTODY AND MEDICAL TREATMENT ONLY. IF YOU DESIRE A MORE COMPREHENSIVE DURABLE POWER

OF ATTORNEY THAT GRANTS AUTHORITY FOR PURPOSES OF HANDLING FINANCIAL OR BUSINESS A

FAIRS, PLEASE CONSULT AN ATTORNEY.

SECTION I: APPOINT OF ADVOCATE

The first several blanks in the form are for putting you name and the name(s) of persons you are

appointing as your advocate or successor advocate. You may appoint ANY person who is at least 18 years

of age or older and of sound mind to be your advocate. It is important that you consult with the person

you are naming and secure his or her consent before naming that person.

The law requires that before you can be considered unable to participate in medical treatment

decisions that determination must be made by your attending physician and at least one other physician or

a licensed psychologist. Because some individual’s religious beliefs may not allow for an examination by a

physician, the document can state the religious objection and indicate how it shall be determined when the

patient advocate may exercise his or her powers.

SECTION II: GRANTS OF AUTHORITY AND RESPONSIBILITY

This is a crucial section of the durable power of document. You may check any, all, or none of the

grants of power. If you do not check any of the options, you will need to attach your own written grants of

power to indicate what powers your advocate will have.

This section contains the very important provision regarding whether decisions to withhold or

withdraw treatment, which would allow you to die, will be made for you. Due to the serious nature of this

granting of power, Michigan law requires that you express in a clear and convincing manner that your

patient advocate is authorized to make such a decision, and that you acknowledge that such a decision

could or would allow your death. If you do grant this authority, you should make clear to you advocate

your desires of treatment. Section III of the form provides a space for setting forth your desires.

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