Patient Advocate Designation

 

What is a Patient Advocate Designation?

 

A patient advocate designation is a document in which a person, the “patient”, appoints another person as their “patient advocate” to make health care decisions for them if, and only if, the patient cannot communicate their own health care decisions due to their incapacity.  This is a “springing” type of power of attorney in that it becomes active only during the incapacity of the patient to speak for his or herself.  The authority of the patient advocate designation is suspended once a patient regains the ability to participate in decisions regarding their health care.  The patient reserves the right to revoke the patient advocate designation when they are of sufficient capacity to do so.

 

A patient advocate designation can communicate the patient’s desires regarding on care, custody, medical treatment and mental health treatment, the making of an anatomical gift, and desires regarding the resolution of a conflict between a health care directive and the administration of means necessary to ensure the medical suitability of the anatomical gift.

 

What can a Patient Advocate Do?

 

Pursuant to MCL 700.5509, the patient advocate has the following authority, rights, responsibilities and limitations:

 

(a) A patient advocate shall act in accordance with the standards of care applicable to fiduciaries in exercising his or her powers.

 

(b) A patient advocate shall take reasonable steps to follow the desires, instructions, or guidelines given by the patient while the patient was able to participate in decisions regarding care, custody, medical treatment, or mental health treatment, as applicable, whether given orally or as written in the designation.

 

(c) A patient advocate shall not exercise powers concerning the patient's care, custody, and medical or mental health treatment that the patient, if the patient were able to participate in the decision, could not have exercised on his or her own behalf.

 

(d) The designation cannot be used to make a medical treatment decision to withhold or withdraw treatment from a patient who is pregnant that would result in the pregnant patient's death.

 

(e) A patient advocate may make a decision to withhold or withdraw treatment that would allow a patient to die only if the patient has expressed in a clear and convincing manner that the patient advocate is authorized to make such a decision, and that the patient acknowledges that such a decision could or would allow the patient's death.

 

(f) A patient advocate may choose to have the patient placed under hospice care.

 

(g) A patient advocate under this section shall not delegate his or her powers to another individual without prior authorization by the patient.

 

(h) With regard to mental health treatment decisions, the patient advocate shall only consent to the forced administration of medication or to inpatient hospitalization, other than hospitalization as a formal voluntary patient under section 415 of the mental health code, 1974 PA 258, MCL 330.1415, if the patient has expressed in a clear and convincing manner that the patient advocate is authorized to consent to that treatment. If a patient is hospitalized as a formal voluntary patient under an application executed by his or her patient advocate, the patient retains the right to terminate the hospitalization under section 419 of the mental health code, 1974 PA 258, MCL 330.1419.

 

 It is clear from the law that the patient advocate does have the power of authority to cause medical treatment to be withdrawn or withheld, even if that may result in the patient’s death.  The patient advocate is also authorized under Michigan law to execute a do not resuscitate order on behalf of the patient.  The purpose of the patient advocate designation is to make clear what the patient’s wishes are in such a situation and to have the patient advocate act upon those wishes.

 

What do I need for a Valid Patient Advocate Designation?

 

A person must be at least 18 years old, of sound mind, and not under duress, fraud or undue influence to execute this document.  A patient advocate designation must be executed in the presence of and signed by two witnesses, and neither witness can be the patient’s spouse, parent, child, grandchild, sibling, presumptive heir, known devisee at time of witnessing, physician, patient advocate or the employee of a life insurance, health insurance, health facility, home for the aged, community mental health service or hospital providing services for the patient.  The document must be given to the physician or other treating authority to be made part of the health record before implementation.

The proposed patient advocate must sign an acceptance of the patient advocate designation before it can be implemented.

 

Do I need a Valid Patient Advocate Designation?

 

Michigan is one of only a few states that do not have a statute for a living will.  A living will, also known as an advance health care directive. is a legal document in which a person specifies what actions should be taken for their health if they are no longer able to make decisions.  However, a patient advocate designation may be the means to communicate what kinds of decision that you would like to have made for you in end-of-life situations and to have a trusted person act on your behalf.

 

Consulting with an attorney is always a good idea before executing such a document to ensure that all of your wishes and desires are communicated clearly.