Michigan Living Will Template
This Living Will is created in accordance with Michigan state laws regarding advance directives. It allows you to express your wishes regarding medical treatment in the event that you become unable to communicate those wishes yourself.
Please fill in the blanks below to complete your Living Will:
Personal Information
- Name: ___________________________
- Date of Birth: ___________________________
- Address: ___________________________
- City: ___________________________
- State: Michigan
- Zip Code: ___________________________
Living Will Declaration
I, ___________________________, being of sound mind, do hereby declare this to be my Living Will. If I am diagnosed with a terminal condition or if I am in a persistent vegetative state, I do not wish to receive the following medical treatments:
- Cardiopulmonary resuscitation (CPR)
- Mechanical ventilation
- Tube feeding
- Dialysis
- Other: ___________________________
If I am unable to communicate my wishes, I appoint the following individual as my healthcare proxy:
Healthcare Proxy Information
- Name: ___________________________
- Relationship: ___________________________
- Phone Number: ___________________________
This Living Will expresses my wishes regarding medical treatment. I understand that I can revoke this document at any time while I am still competent to do so.
Signature
Signed this ___ day of __________, 20___.
_____________________________
(Your Signature)
Witnesses
This Living Will must be signed in the presence of two witnesses who are not related to you and who will not inherit from you:
- Witness 1: ___________________________
- Witness 2: ___________________________
Witnesses must sign below:
_____________________________
(Witness 1 Signature)
_____________________________
(Witness 2 Signature)
By completing this Living Will, you are taking an important step in ensuring that your medical wishes are known and respected. It is advisable to discuss your wishes with your healthcare provider and loved ones.