Michigan Living Will Template
This Living Will is designed to meet Michigan state laws regarding advanced medical directives. It allows you to express your wishes regarding medical treatment should you become unable to communicate them yourself.
By completing this document, you ensure that your healthcare decisions align with your personal values and preferences.
Instructions
Please fill in the blanks below with your personal information.
Your Name: _______________________________
Your Address: _______________________________
City: _______________________________
State: Michigan
Zip Code: _______________________________
Date of Birth: _______________________________
Phone Number: _______________________________
Declaration
I, [Your Name], voluntarily make this declaration regarding my medical care. If my attending physician determines that I am unable to make my own healthcare decisions and I am in a persistent vegetative state, terminal condition, or an irreversible condition, I specify the following:
- 1. I do not wish to receive life-sustaining treatment if:
- a. I am in a terminal condition.
- b. I am in a persistent vegetative state.
- c. I am diagnosed with an irreversible condition.
- 2. I wish to receive comfort care, including medications for pain relief.
- 3. I want my loved ones to know my wishes as expressed in this document.
Additional Instructions
In the event that I am unable to make decisions about my healthcare, I would like the following instructions to be followed:
- Hold a meeting with my family to discuss my wishes.
- Respect my decision regarding life-sustaining treatment.
- Consult my appointed healthcare representative (if applicable).
Signature
By signing below, I confirm that I understand the contents of this Living Will and that I am of sound mind.
Signature: _______________________________
Date: _______________________________
Witnesses
This document must be signed in the presence of at least two witnesses who are not your relatives or beneficiaries. Each witness must also sign below:
Witness 1 Name: _______________________________
Witness 1 Signature: _______________________________
Witness 2 Name: _______________________________
Witness 2 Signature: _______________________________
It is recommended to keep a copy of this Living Will accessible to your medical providers and family members. Additionally, consider discussing your preferences with them to ensure everyone is aware of your wishes.