Michigan Patient Advocate Designation: Who Makes Medical Decisions When You Cannot?

Michigan does not have a “living will”

Many states let you sign a “living will” that directly states your end-of-life wishes. Michigan is different. Michigan law makes a patient advocate designation legally binding as a way to appoint someone to make health-care decisions for you (MCL 700.5511), and the process is governed by MCL 700.5506 to 700.5515, part of the Estates and Protected Individuals Code (EPIC). What Michigan does not have is a statute that makes a standalone “living will” independently binding on its own.

A patient advocate designation is one of several advance directives Michiganders use. Others include an out-of-hospital do-not-resuscitate declaration under the Michigan Do-Not-Resuscitate Procedure Act (MCL 333.5671 to 333.5685) and the Michigan physician orders for scope of treatment, commonly called MI-POST. This article is about the one document that lets you choose who decides for you.

The living-will distinction still matters in a practical way. Even though a written “living will”-style statement is not independently binding in Michigan, it is not meaningless. It can serve as evidence of what you wanted and can guide your patient advocate and your doctors (see the Michigan Legislature’s advance-directive guide). The statute also lets you fold that kind of statement of your wishes right into the designation (MCL 700.5507), where it has the clearest effect.

What a patient advocate designation does

In a patient advocate designation, you (the law calls you the “patient”) name another adult (your “patient advocate”) to make decisions about your care, custody, and medical or mental-health treatment when you are unable to make them yourself (MCL 700.5506). You can also give your advocate authority to make an anatomical gift, meaning to donate organs or tissue.

The authority does not become active the moment you sign, and your advocate does not get to decide on their own that your incapacity has arrived. By law, the designation becomes exercisable only after your inability to participate has been formally determined. For medical treatment decisions, your attending physician and a second physician or licensed psychologist must examine you and determine, in writing, that you are unable to participate in your own medical decisions. That determination goes into your medical record and must be reviewed at least once a year (MCL 700.5508). If a dispute arises about whether you can participate, the statute allows the question to be taken to court.

Mental-health treatment decisions follow a separate, stricter rule. Your advocate may make them only if a physician and a mental-health practitioner both examine you and certify, in writing, that you are unable to give informed consent to mental-health treatment (MCL 700.5515). In short, incapacity is not self-evident, and it is not the advocate’s call. It is a documented medical determination. As long as you can make and communicate your own choices, you remain in charge.

What Michigan requires for the document to be valid

Under MCL 700.5506, a valid patient advocate designation must meet several requirements:

• You must be 18 or older and of sound mind when you sign, and the advocate you name must also be 18 or older.
• The designation must be in writing, signed, dated, and made voluntarily.
• It must be signed in front of two witnesses.
• Certain people cannot serve as a witness: your spouse, parent, child, grandchild, sibling, presumptive heir, or a known devisee (someone you already know to be named to take under your will); any physician; the patient advocate; or an employee of your life or health insurer, of a health facility treating you, of a home for the aged where you live, or of a community mental health services program or hospital providing you mental-health services.

One more step is easy to overlook. Before your advocate can act, they must be given a copy of the designation and must sign a written acceptance of the role (MCL 700.5507). The designation also has to be made part of your medical record before it is put into effect.

The end-of-life clause people miss

Many people assume that naming a patient advocate automatically lets that person “pull the plug” if it ever comes to that. In Michigan it does not. Your advocate may make a decision to withhold or withdraw treatment that allows you to die only if you expressed, in a clear and convincing manner, that the advocate is authorized to make that decision, and only if you acknowledged that such a decision could or would allow your death (MCL 700.5507).

That is why the wording matters so much. A generic or incomplete form may fall short if it does not contain Michigan’s required language or does not clearly grant the authority you intend. If the clear language authorizing life-sustaining-treatment decisions is missing, your advocate may be powerless in exactly the situation you were trying to plan for.

Limits the law builds in

Michigan law places firm boundaries on what a patient advocate can do (MCL 700.5512):

• An advocate cannot authorize withholding or withdrawing treatment from a patient who is pregnant if doing so would result in her death.
• No one can require you to sign a designation as a condition of receiving care or insurance, and an insurer cannot penalize you for signing or refusing to sign one.
• A designation does not authorize or condone suicide or homicide, and it cannot be used to force treatment on a patient who objects on religious grounds.

The pregnancy limitation described above is current Michigan law. A pending bill, Senate Bill 33 of 2025, would change it, but as of this writing it has only passed the Senate and remains before a House committee, so it is not law.

Your advocate’s duties come from a different part of the statute. Under MCL 700.5507, the advocate serves without compensation (though actual and necessary expenses may be reimbursed) and must act as a fiduciary, in your best interests, guided by the wishes you expressed while you were able to participate.

When it starts, and how to change your mind

Because the authority only applies when you cannot participate in your own decisions, signing the designation today does not hand control to anyone while you are well. And you keep the power to change course. You may revoke a patient advocate designation at any time and in any manner sufficient to communicate that you intend to revoke it (MCL 700.5507). The one narrow exception is that if you chose to waive your right to revoke as to mental-health treatment, that revocation can be delayed up to 30 days (MCL 700.5515).

Where it fits in your estate plan

A patient advocate designation covers your medical decisions. It does not cover your finances. That is the job of a separate durable (financial) power of attorney, which lets someone manage money and property if you are incapacitated. A complete Michigan plan usually pairs both of those with a will or a revocable living trust, so that both halves of the picture, what happens to your health and what happens to your property, are handled by people you chose.

A Michigan estate-planning attorney can help ensure that your designation grants the authority you intend, records your treatment preferences clearly, and works with the rest of your plan.

Frequently asked questions

Is a patient advocate designation the same as a living will?

Not exactly. Michigan does not have a statute that makes a standalone living will independently binding, so the patient advocate designation is the document that carries the clearest legal weight for appointing a decision-maker. A written statement of your wishes is still worthwhile because it can serve as evidence of what you wanted, and Michigan lets you include that statement inside the designation.

Who can I name as my patient advocate in Michigan?

Any adult 18 or older whom you trust to speak for you, often a spouse, adult child, or close friend. A separate rule governs witnesses: certain relatives, any physician, and certain facility and insurer employees cannot witness your signing.

When does a patient advocate designation take effect?

Only after your inability to participate is formally determined, not the moment you sign and not when your advocate decides. For medical decisions, your attending physician and a second physician or licensed psychologist must determine in writing that you cannot participate. Mental-health decisions require a physician and a mental-health practitioner to certify in writing that you cannot give informed consent.

Can my patient advocate make end-of-life decisions?

Only if your designation clearly authorizes it. Michigan requires that you expressed, in a clear and convincing manner, that your advocate may make a decision to withhold or withdraw life-sustaining treatment, and that you acknowledged such a decision could allow you to die.

Can I change or cancel my patient advocate designation?

Yes. You can revoke it at any time and in any manner that communicates your intent to revoke, with a narrow exception: if you waived revocation as to mental-health treatment, that revocation can be delayed up to 30 days.