Michigan Advance Directive Form: How to Complete Your Patient Advocate Designation

Your parent is heading into surgery next week, and the hospital just asked whether they have an advance directive on file. You're scrambling — but you don't even know what Michigan requires, because this state does things differently than almost every other state in the country.

Michigan doesn't use the term "advance directive" in its statutes the way most states do. Instead, the primary legal document is called a Patient Advocate Designation (PAD), governed by MCL 700.5506 of the Estates and Protected Individuals Code. This document appoints a trusted person — your patient advocate — to make medical decisions when you can no longer speak for yourself.

What Makes Michigan's Advance Directive Different

In most states, you sign a health care proxy form and a separate living will. Michigan collapses everything into one document: the Patient Advocate Designation.

The PAD can cover medical decisions, mental health treatment, and even custody matters. But the critical difference is this: if you want your advocate to have the authority to withhold or withdraw life-sustaining treatment, you must include specific language stating that you acknowledge this authority "could or would allow your death." Vague phrases like "no heroic measures" won't satisfy Michigan's "clear and convincing evidence" standard.

Michigan does not require notarization for a Patient Advocate Designation. Two qualified witnesses are sufficient. This is a common point of confusion — many families waste time and money getting documents notarized when the statute doesn't require it.

Who Can Witness Your Michigan Advance Directive

Michigan's witness rules under MCL 700.5506(4) are among the strictest in the country. You need two adult witnesses, and both must be completely disinterested parties.

These people cannot serve as witnesses:

• Your spouse, parent, child, grandchild, or sibling
• Anyone who would inherit from you (presumptive heirs)
• Your designated patient advocate
• Your treating physician
• Employees of your health or life insurance provider
• Employees of the health facility where you're being treated
• Staff at a home for the aged where you reside
• Employees of a community mental health program treating you

This creates a real problem for isolated or institutionalized seniors. If you're in a nursing home, none of the staff can witness your document. Reach out to neighbors, church members, or community volunteers. Some Michigan libraries and senior centers offer free notary and witnessing services.

The 10-Statement Acceptance Requirement

This is where most DIY planners stumble. Before your patient advocate can legally act on your behalf, they must sign a written acceptance containing ten specific statutory statements acknowledging their fiduciary duties under MCL 700.5507.

These statements include acknowledging that they cannot receive compensation, that they're bound to act in your best interest, and that they understand the scope of their authority. Without this signed acceptance, your advocate has no legal standing — even if the rest of the document is perfectly executed.

Step-by-Step Signing Process

1. Choose your advocate — one primary, plus optional successors. Michigan does not allow co-advocates to act jointly on medical decisions.
2. Draft your specific treatment preferences — be explicit about ventilators, CPR, artificial nutrition, dialysis, and comfort care.
3. Include the death-acknowledgment language if you want end-of-life authority granted.
4. Find two qualified witnesses who don't fall into any disqualified category.
5. Sign in the presence of both witnesses — they sign concurrently with you.
6. Have your advocate sign the 10-statement acceptance — this can happen at the same ceremony or later, but it must happen before they can act.
7. Distribute copies to your advocate, your physician, your hospital, and your family members.
8. Register with the Michigan Peace of Mind Registry for electronic retrieval by medical providers statewide.

After April 2026: The Pregnancy Exclusion Is Gone

Until recently, every Michigan advance directive was required to include a clause preventing a patient advocate from withdrawing life-sustaining treatment if the patient was pregnant. On April 16, 2026, in Koskenoja v. Whitmer, the Michigan Court of Claims declared this pregnancy exclusion unconstitutional under the 2022 reproductive freedom amendment.

If you're using a template that still includes this mandatory pregnancy language, it's outdated. Updated templates reflect your full bodily autonomy regardless of pregnancy status.

What to Do Right Now

The biggest risk isn't getting a form wrong — it's not having one at all. Without a valid Patient Advocate Designation, your family will need to petition the Probate Court for guardianship if you become incapacitated. That process is public, expensive, and slow.

The Michigan Advance Directive & Living Will Kit walks you through the complete Patient Advocate Designation, witness verification, and advocate acceptance process with Michigan-specific instructions for every step.

See more Michigan guides →