Michigan Living Will
Michigan Living Will
I. Declaration of Wishes
I, [Your Name], residing at [Your Address], being of sound mind, being of sound mind, and acting voluntarily, hereby declare my wishes regarding medical treatment and life-sustaining procedures in the event of my incapacity to communicate my desires.
II. Healthcare Proxy Appointment
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In addition to this document, I appoint [Name of Healthcare Agent] residing at [Agent's Address] as my healthcare agent.
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My healthcare agent shall have the authority to make healthcare decisions on my behalf if I am unable to communicate my wishes.
III. Specific Instructions
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If I am diagnosed with a terminal illness or irreversible condition, I authorize my healthcare agent and medical providers to implement or withhold specific medical interventions based on the guidance provided in this living will.
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I trust my healthcare agent to ensure my wishes are honored and request that my family and medical team respect the decisions made by my designated agent.
IV. Medical Treatment Preferences
If I am diagnosed with a terminal condition or in a persistent vegetative state where there is no reasonable expectation of recovery, I request the following:
(a) I wish to receive (or not receive) life-sustaining treatments, including but not limited to:
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Cardiopulmonary resuscitation (CPR)
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Mechanical ventilation
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Artificial nutrition and hydration (tube feeding)
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Dialysis
(b)I understand that comfort care and pain management are priorities for me in such circumstances.
V. Legal Declaration
5.1 This Michigan Living Will reflects my wishes regarding medical treatment and end-of-life care and supersedes any conflicting instructions provided by me previously.
5.2 I sign this document on [Date of Signing] at [Location of Signing] in the presence of witnesses as required by Michigan law.
Declarant
[Your Name]
Witness 1
Name: [Witness 1 Name]
Address: [Witness 1 Address]
Witness 2
Name: [Witness 2 Name]
Address: [Witness 2 Address]
VI. Notary Acknowledgment
County of [County Name], State of Michigan
On this [Date], before me, [Notary's Name], a notary public in and for the said state, personally appeared [Your Name], known to me to be the person described in and who executed the foregoing instrument, and acknowledged that he/she executed the same as his/her free act and deed.
Witness my hand and official seal.
Notary Public: [NOTARY'S NAME]
My Commission Expires: [EXPIRATION DATE]
