Michigan Living Will Template
This Living Will is created in accordance with Michigan state laws regarding advance directives. It allows you to express your preferences for medical treatment if you become unable to communicate your wishes.
Please fill in the following information:
- Full Name: ___________________________________
- Date of Birth: _______________________________
- Address: ____________________________________
- City, State, Zip Code: _______________________
- Phone Number: _______________________________
In this document, I express my wishes regarding my healthcare decisions. If I am unable to communicate my preferences due to illness or injury, I wish to provide the following directives:
- I do not want my life to be prolonged by any means if I am terminally ill or in a persistent vegetative state.
- I would like to receive comfort care, including pain relief, even if it may hasten my death.
- If I become unable to make decisions about my healthcare, I appoint the following person to make such decisions on my behalf:
- Name of Healthcare Proxy: ___________________________________
- Relationship: _________________________________________
- Phone Number: _______________________________________
- I authorize my healthcare proxy to make all healthcare decisions for me consistent with this Living Will.
- These directives should be followed by my healthcare providers and family members to the best of their abilities.
Signed this ____ day of ____________, 20__.
_____________________________
(Signature of Declarant)
_____________________________
(Witness Signature)
_____________________________
(Witness Signature)
It is recommended to keep a copy of this Living Will in a safe place and provide copies to your healthcare proxy and family members.