DNR, MI-POST, and Patient Advocate Designations: Understanding Michigan’s Healthcare Directives

When planning for the end of life or a severe medical emergency, the paperwork can feel overwhelming. Many families in Michigan mistakenly use terms like 'DNR,' 'Living Will,' and 'Power of Attorney' interchangeably. This confusion is not just a technicality-it can result in emergency responders administering unwanted CPR, or doctors keeping a loved one on life support against their wishes.

In Michigan, there are three distinct, highly specific healthcare directives you need to understand. Each document serves a unique purpose, is governed by a different set of state statutes, and speaks to different medical professionals. In this guide, we will eliminate the confusion by breaking down the exact differences between a Patient Advocate Designation, an Out-of-Hospital DNR, and the MI-POST, ensuring you know exactly which form to request from your physician or attorney.

Decoding Michigan's End-of-Life Directives

The fundamental rule of Michigan healthcare law is that medical professionals must have explicit, legal authorization to withhold life-saving treatments. Without the correct form, EMTs and emergency room doctors will default to keeping you alive at all costs. Let's examine the three pillars of Michigan healthcare directives.

1. The Patient Advocate Designation (Healthcare POA)

In many states, this is known as a Healthcare Power of Attorney or a Medical Proxy. In Michigan, under Mich. Comp. Laws § 700.5506, it is officially called a Patient Advocate Designation. This is a broad planning document intended for healthy adults of any age. By signing this document, you are not making an immediate medical decision; instead, you are naming a trusted person (your 'surrogate') to make medical choices for you *only* if you become mentally incapacitated (e.g., in a coma or suffering from advanced dementia).

As affirmed by landmark right-to-die cases like In re Martin, 450 Mich. 204 (MI Supreme Court 1995), Michigan courts demand clear and convincing evidence of a patient's wishes regarding the withdrawal of life support. A properly drafted Patient Advocate Designation provides this evidence, allowing your appointed agent to pull the plug if you have explicitly granted them that power in writing.

2. The Out-of-Hospital Do-Not-Resuscitate (DNR) Order

The Michigan Do-Not-Resuscitate Procedure Act, Mich. Comp. Laws § 333.1051, governs the out-of-hospital DNR. Unlike a Patient Advocate document, a DNR is not for healthy people appointing a surrogate. It is a specific medical order signed by both you (or your advocate) and your doctor. You will typically sign Form Statutory, Michigan, Michigan Legislature, Do-Not-Resuscitate Order.

This document has one extremely narrow purpose: if your heart stops or you stop breathing outside of a hospital (e.g., in your living room or at a restaurant), EMTs and paramedics will look for this document or an authorized DNR bracelet. If they see it, they will not perform CPR, use a defibrillator, or insert a breathing tube. They will simply allow natural death to occur.

3. The MI-POST (Physician Orders for Life-Sustaining Treatment)

The newest addition to Michigan's end-of-life framework is the MI-POST, authorized under Mich. Comp. Laws § 333.5671. The Form MDHHS-5836, Michigan, Department of Health and Human Services, Michigan Physician Orders for Scope of Treatment (MI-POST) is a brightly colored, one-page medical order designed strictly for patients who suffer from a serious, advanced illness or frailty, where a physician would not be surprised if the patient died within the next year.

While a DNR only says 'Do not do CPR,' a MI-POST is much more detailed. It allows a patient to give specific, binding medical orders to doctors and paramedics regarding feeding tubes, the use of ventilators, and whether they want to be transported to a hospital at all, or simply kept comfortable at home.

How Your Surrogate Interacts With a DNR and MI-POST

These documents work together in a hierarchy. If you are a healthy 40-year-old, you only need a Patient Advocate Designation. If you develop terminal cancer at age 75, your physician will likely suggest adding a MI-POST or a DNR to your file. If you are incapacitated, the person you named in your Patient Advocate Designation has the legal authority to sign a DNR or a MI-POST on your behalf, ensuring your final wishes are respected when you cannot speak for yourself. Without the original designation, your family would have to petition a court, such as the Kent County Probate Court, Grand Rapids, to gain the authority to sign a DNR for you.

How Much Does It Cost to Draft These Directives?

Protecting your medical wishes is a highly affordable part of estate planning:

• MI-POST and DNR Orders: These are actual medical forms. They are generally free and provided by your doctor or the Michigan Department of Health and Human Services, Lansing during a routine medical appointment.
• Patient Advocate Designation: Because this requires careful legal drafting of your end-of-life wishes and the appointment of an agent, hiring a lawyer usually costs between $150 and $350 for a standalone document.
• Full Estate Plan: Most attorneys include the Patient Advocate Designation as part of a comprehensive Will and Trust package, which generally runs from $1,500 to $3,500 in Michigan.

Frequently Asked Questions (FAQ)