Michigan Living Will
This Living Will is created in accordance with Michigan Compiled Laws Section 700.5501 et seq.
I, [Full Name], born on [Date of Birth], residing at [Address], am of sound mind and wish to execute this Living Will to outline my healthcare preferences in the event that I am unable to communicate my wishes.
1. Identifier of Health Care Agent:
I designate the following individual as my health care agent:
Name: [Agent's Full Name]
Address: [Agent's Address]
Phone: [Agent's Phone Number]
2. Healthcare Instructions:
In the event that I am unable to make decisions regarding my medical treatment, I express my wishes regarding end-of-life care:
- I choose to have life-sustaining treatment withheld or withdrawn under the following circumstances: [Specify Conditions].
- I do not wish to receive cardiopulmonary resuscitation (CPR).
- I request comfort measures only, including pain relief, even if it may hasten my death.
- I desire to make the decision about whether to donate any of my organs or tissues after death. [Yes/No].
3. Revocation:
This Living Will can be revoked by me at any time, either verbally or in writing, provided that this revocation is communicated to my health care agent.
4. Witnesses:
By signing this Living Will, I affirm that I am of legal age and not under duress:
- Witness Name: [Witness 1 Full Name] - Signature: [Signature] - Date: [Date]
- Witness Name: [Witness 2 Full Name] - Signature: [Signature] - Date: [Date]
5. Signature:
I hereby declare that this Living Will reflects my wishes regarding healthcare decisions. I understand its contents and have signed it willingly.
Signature: [Your Signature] Date: [Date]