Michigan Living Will Template
This Living Will is created in accordance with Michigan state laws regarding advance directives. This document allows you to express your wishes regarding medical treatment in the event that you become unable to communicate your decisions.
Instructions: Fill in the blanks with your personal information where indicated.
Personal Information:
- Name: ____________________________________
- Date of Birth: _____________________________
- Address: ___________________________________
- City: ______________________________________
- State: Michigan
- Zip Code: _________________________________
Declaration:
I, _______________________________, being of sound mind, willfully and voluntarily make this declaration regarding my medical treatment. I understand that this document will guide my healthcare providers in making decisions about my care if I am unable to communicate my wishes.
In the event that I am diagnosed with a terminal condition or am in a persistent vegetative state, I wish to make the following choices regarding my medical treatment:
- Choose to receive life-sustaining treatment: Yes / No
- Choose to receive nutrition and hydration: Yes / No
- Choose to receive pain relief, even if it may hasten my death: Yes / No
Additional Instructions:
If there are specific instructions or preferences that you would like your healthcare providers to follow, please detail them here:
__________________________________________________________
__________________________________________________________
Signature:
______________________________
Date: ________________________
Witnesses:
This document must be signed in the presence of two witnesses who are at least 18 years old and who are not related to you by blood or marriage, nor entitled to any part of your estate.
- Witness 1 Name: ___________________________ Signature: __________________________
- Witness 2 Name: ___________________________ Signature: __________________________
This Living Will is intended to be a legally binding document under Michigan law. Ensure that you keep a copy for your records and provide copies to your healthcare providers and family members.