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Understanding DNR Orders and Patient Advocate Designations in Michigan

Posted by Andrew R. Byers | Oct 31, 2024 | 0 Comments

As an elder law attorney in Michigan, I often receive questions about Do-Not-Resuscitate (DNR) orders and how they interact with other advance directives. Let's dive into the details of DNR orders, Patient Advocate Designations, and when you might need both.

DNR Orders in Michigan

A DNR order is a legal document that instructs healthcare providers not to perform cardiopulmonary resuscitation (CPR) if your heart stops beating or you stop breathing. In Michigan, DNR orders are governed by specific laws and procedures.

Key points about DNR orders:

  • They only apply to CPR and do not affect other medical treatments.
  • They must be signed by both you and your attending physician.
  • You can revoke them at any time.

Patient Advocate Designation

A Patient Advocate Designation, also known as a Durable Power of Attorney for Healthcare, is a separate legal document under MCL 700.5506. This document allows you to appoint someone to make medical decisions on your behalf if you become incapacitated.

Important aspects of Patient Advocate Designations:

  • They cover a broader range of medical decisions beyond just CPR.
  • They only take effect when you're unable to make decisions for yourself.
  • Your patient advocate must accept their role in writing.

How DNR Orders and Patient Advocate Designations Work Together

It's crucial to understand that a DNR order does not replace the need for a Patient Advocate Designation. These documents serve different purposes and can work in tandem to ensure your healthcare wishes are respected.

Situations when you might need both:

  • You want to avoid CPR but still want someone to make other medical decisions for you if you are incapacitated, but not suffering a medical emergency requiring resuscitation.
  • You want your patient advocate to have the authority to issue a DNR order on your behalf if necessary.

Patient Advocates and DNR Orders

Under Michigan law, your patient advocate can issue a DNR order for you if you've granted them that authority in your Patient Advocate Designation. This can be particularly useful if your health declines and you're unable to make decisions for yourself in the future, i.e., you become too impaired to issue a DNR order.

To enable this:

  • Explicitly state in your Patient Advocate Designation that your advocate has the power to issue a DNR order.
  • Discuss your wishes regarding CPR with your patient advocate in advance.

DNR Bracelets

In some cases, you might want to consider getting a DNR bracelet in addition to your written DNR order. This can be helpful in emergency situations where healthcare providers might not have immediate access to your paperwork.

The purpose of the DNR order is to prevent first responders—EMS, paramedics, ambulance service, doctor, nurse, and others—from instituting life support measures. The medical personnel who arrive at your location (if outside of a hospital) are to check for vital signs. If finding none, personnel are to check for the DNR order or identification bracelet. If either is found, the first responder is directed not to resuscitate the declarant under Michigan law.

Consider a DNR bracelet if:

  • You frequently travel or spend time away from home.
  • You have a terminal illness or are in hospice care.
  • You want to ensure your DNR wishes are known immediately in an emergency.

If you suffer a medical event where you would not want to be resuscitated but do not have your DNR with you or a DNR bracelet, first responders will have to attempt to resuscitate you, even if a family member is with you and tells the first responders you have a DNR order and do not want to be resuscitated. By law, if you cannot communicate with the first responders, they can only legally take direction from your DNR order or bracelet, not someone else.

Take Action to Protect Your Wishes

As an elder law attorney, I am periodically called on to meet with people who are laid up in their home, in the hospital, or in a nursing home who are experiencing an urgent medical situation or transition to long-term care and who never got around to making advance medical directives like DNR orders and Patient Advocate Designations. While I am happy to help in these situations, doing health care planning in situations like this is less then optimal for the following reasons:

  • First, having to find, meet with and otherwise interact with an attorney is just one more task that has to be done in an otherwise stressful situation when the person who needs healthcare planning is suffering an illness or transitioning to long-term care.
  • Second, it's more expensive to sign these documents at hospitals or nursing homes because the legal fee is based in part on the amount of time that will be involved, so time driving between facilities and the office has to be factored into the overall price. It's less expensive if you can come to my office to sign these documents when you are not experience a health crisis.
  • Third, the medical directives have to be witnessed and  it can be hard to find witnesses in hospitals, assisted living, and nursing homes because the staff that work there are prohibited from acting as witnessed under Michigan law.
  • Fourth, if the person who needs the DNR order and Patient Advocate has dementia or is very ill, they may not have the legal capacity to issue these medical directives. Michigan law requires that we know what we are doing when we sign legal documents. This is referred to as legal or mental capacity. This means the person signing the medical directives must:
    1. Understand the nature and consequences of a DNR order
    2. Be able to communicate their wishes clearly
    3. Be free from undue influence or coercion

If the person does not have sufficient mental capacity to issue these medical directives, or if it is not clear that they have sufficient capacity, a family member may have to file for guardianship in probate court, which is a slower, more complicated process that results in ongoing involvement of the probate court.

Navigating the complexities of DNR orders and Patient Advocate Designations can be challenging. As an elder law and estate planning attorney in Troy, Michigan, I'm here to help ensure your healthcare wishes are properly documented and legally binding.

Don't leave your end-of-life care decisions to chance. Contact me, Andrew Byers, if you have questions or need help with documenting your healthcare preferences. You can contact me now by using the online form or calling me directly at (248) 469-4261. On this initial call, I'll answer your preliminary questions and get some background information to make sure it's a situation I can help with. After that, you can decide if it makes sense to schedule a more in-depth consultation.

About the Author

Andrew R. Byers

Andrew Byers' elder law practice focuses on the legal needs of older clients and their families, and works with a variety of legal tools and techniques to meet the goals and objectives of the older client. Under this holistic approach, I handle estate and longevity planning issues and counsel cli...

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Andrew Byers is an estate planning, elder law, and probate attorney in Troy, Michigan with 27 years of practical experience you can use to safeguard your savings and protect yourself. I strive to help my clients avoid and solve problems with clear, effective, and affordable legal services and counsel. I advise clients in Troy, Michigan and surrounding communities in Oakland County and the rest of Metro Detroit. Take the first step to obtaining peace of mind by contacting me using the online form or by calling (248) 469-4261.

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