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DNR Comfort Care.
Comfort measures continue; CPR is withheld.
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Resources / Advance Care Planning
Advance Care Planning Resources.
Michigan-specific guidance on POLST, living wills, DPOA-HC, and DNR orders — what each document does, when it matters, and how to complete them.
"Before the moment you need them."
Plain-language guidance for Michigan families.
Most people intend to get their advance care planning documents in order. Most of them don't. The reason usually isn't reluctance — it's that the process feels unfamiliar, the documents sound similar, and nobody has sat down and explained what each one actually does.
This page does that. What follows is a plain-language explanation of each major advance care planning document used in Michigan, the differences between them, when they take effect, and how to complete them. If you're facing a serious illness — your own or a loved one's — the right time to have these documents in place is before the moment you need them.
Why Advance Care Planning Matters
It's not about dying. It's about your values.
Advance care planning is the process of identifying what kind of medical treatment you'd want — or not want — if you became unable to speak for yourself. It's not about dying. It's about making sure your values guide your care when the stakes are highest.
Without these documents, medical decisions default to whoever is present and legally authorized — which may or may not be the person you'd choose. And the decisions get made under pressure, in a hospital or emergency room, with no clear guidance about what you actually wanted. That gap falls to the family. It's one of the most painful and avoidable situations in end-of-life care.
The four documents that matter most in Michigan:
- POLST (Physician Orders for Life-Sustaining Treatment)
- Durable Power of Attorney for Healthcare (DPOA-HC)
- Living Will / Patient Advocate Designation
- DNR Order (Do Not Resuscitate)
Each serves a different function. Having one doesn’t replace the others.
Document 01
POLST — Physician Orders for Life-Sustaining Treatment.
The POLST is a medical order — not just a statement of preferences. That distinction matters enormously. Because it's a physician order, it's immediately actionable by emergency responders, hospital staff, and care teams without requiring interpretation or approval.
Who should have a POLST: patients with a serious illness or advanced age who have specific, documented preferences about life-sustaining treatment. The POLST is completed with a physician or qualified medical professional, signed by both the patient (or their legal representative) and the physician, and kept accessible — on the refrigerator, near the bed, wherever emergency responders can find it quickly.
A critical Michigan-specific note: Michigan adopted a standardized statewide POLST form in 2019. Earlier versions from before that date may still be honored, but when completing a new POLST in Michigan, use the current Michigan Medical Orders for Scope of Treatment (MOST) form — which is Michigan's specific implementation of the POLST paradigm. The Michigan MOST form is available through the Michigan Department of Health and Human Services.
What a POLST is not: it isn't a substitute for a healthcare power of attorney or living will. It's a medical order about specific interventions. The other documents address who makes decisions and what broader values should guide care.
In Michigan, the POLST form covers:
Document 02
Durable Power of Attorney for Healthcare (DPOA-HC).
The Durable Power of Attorney for Healthcare is the most important advance care planning document for most people. It designates a specific person — your patient advocate — to make healthcare decisions on your behalf if you become unable to make them yourself.
In Michigan, the DPOA-HC is governed by the Michigan Patient Advocate Designation Act (MCL 700.5506 et seq.). To be legally valid in Michigan:
Who should you name as your patient advocate? Someone who knows your values, can handle pressure, and will advocate for what you'd actually want — not what they'd want for you. Those are often different people. In real situations, families discover that the person who seems like the obvious choice sometimes struggles most with acting against their own instincts when the moment arrives. Name the person who will follow your instructions, not the one who will be most emotionally affected.
The DPOA-HC should explicitly state whether the patient advocate can authorize withdrawal of life-sustaining treatment, including artificial nutrition and hydration. Michigan law requires this authority to be granted explicitly — it isn't implied.
The more specific the guidance, the more useful.
Document 03
Living Will / Advance Directive.
In Michigan, a "living will" as a standalone document has no formal legal standing under state statute — Michigan does not have a living will law in the way some states do. What Michigan has instead is the Patient Advocate Designation, which combines the powers of attorney with written guidance about treatment preferences.
This surprises many families. A living will document downloaded from a general website may not carry legal weight in Michigan without being properly executed as a Patient Advocate Designation.
What the written portion of a Michigan Patient Advocate Designation should include:
The more specific the written guidance, the more useful it is. Statements like “I don’t want to be kept alive by machines” sound clear but are legally and clinically vague. The guidance that actually helps decision-makers is specific: “If I am in a persistent vegetative state with no reasonable expectation of recovery, I do not want mechanical ventilation or artificial nutrition continued.”
Document 04
DNR Orders (Do Not Resuscitate).
A DNR order is a specific physician order instructing emergency responders and medical staff not to perform CPR if the patient's heart stops or they stop breathing. It's narrower in scope than a POLST — it addresses only the question of resuscitation, not other life-sustaining treatments.
In Michigan, two DNR categories exist:
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DNR Comfort Care – Arrest.
The order activates only when the patient is in cardiac or respiratory arrest — comfort care continues until that point.
Michigan requires a specific bright orange DNR identification bracelet or necklace for out-of-hospital DNR orders to be honored by emergency medical services. A document alone isn't sufficient — EMS will initiate resuscitation unless the orange identification is present. This is one of the most commonly missed practical details in advance care planning.
For hospice patients, a DNR is typically part of the overall care plan. If your loved one is enrolled in hospice without a DNR, that's a conversation worth having with the hospice team early.
How These Documents Work Together
Most families need more than one document — the right combination depends on the situation.
/ 01
A healthy adult completing advance planning
DPOA-HC (Patient Advocate Designation) with written treatment preferences
/ 02
A patient with serious illness at home or in a facility
DPOA-HC + POLST/Michigan MOST form
/ 03
A hospice patient
DPOA-HC + POLST + DNR, coordinated with the hospice care plan
The hierarchy in Michigan: physician orders (POLST, DNR) direct immediate medical action. The DPOA-HC governs broader decision-making when the patient lacks capacity. When documents conflict, physician orders generally take precedence in emergencies — which is why it’s essential to keep all documents consistent and updated.
Completing These Documents in Michigan
Standardized forms are available — here's where to find them.
The Michigan Department of Health and Human Services provides standardized forms for the Michigan MOST (POLST equivalent) and the Patient Advocate Designation. Resources:
Once completed, provide copies to your physician, your patient advocate, and any healthcare facility where you receive regular care. Keep the originals accessible at home — not locked in a safe or stored with an attorney — because the documents need to be available to medical staff immediately when they’re needed.
How We Can Help
These conversations are part of what we do every day.
Advance care planning conversations are part of what our social work team and chaplains do every day. If you or a loved one is facing a serious illness and these documents aren’t yet in place, we can walk through the options, explain what each document does, and connect you with the right resources — whether or not your loved one is currently enrolled in hospice.