Michigan Laws 333.1056 – Execution of order under MCL 333.1055; form
Current as of: 2023 | Check for updates
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Terms Used In Michigan Laws 333.1056
- Declarant: means an individual who has executed a do-not-resuscitate order on his or her own behalf or on whose behalf a do-not-resuscitate order has been executed as provided in this act. See Michigan Laws 333.1052
- Fraud: Intentional deception resulting in injury to another.
- identification bracelet: means a wrist bracelet that meets the requirements of section 7 and that is worn by a declarant while a do-not-resuscitate order is in effect. See Michigan Laws 333.1052
- order: means a document executed under this act directing that, if an individual suffers cessation of both spontaneous respiration and circulation in a setting outside of a hospital, resuscitation will not be initiated. See Michigan Laws 333.1052
- Patient advocate: means an individual who is designated to make medical treatment decisions for a patient under section 5506 to 5515 of the estates and protected individuals code, 1998 PA 386, MCL 700. See Michigan Laws 333.1052
- person: may extend and be applied to bodies politic and corporate, as well as to individuals. See Michigan Laws 8.3l
- resuscitate: means perform cardiopulmonary resuscitation or a component of cardiopulmonary resuscitation, including, but not limited to, any of the following:
(i) Cardiac compression. See Michigan Laws 333.1052
A do-not-resuscitate order executed for an adherent of a church or religious denomination under section 5 shall include, but is not limited to, the following language, and shall be in substantially the following form:
| “DO-NOT-RESUSCITATE ORDER | ||||
| Use the appropriate consent section below: | ||||
| A. DECLARANT CONSENT | ||||
| I request that in the event my heart and breathing should stop, no person shall attempt to resuscitate me. | ||||
| This order will remain in effect until it is revoked as provided by law. | ||||
| Being of sound mind, I voluntarily execute this order, and I understand its full import. | ||||
| _______________________________________ | _______________ | |||
| (Declarant’s signature) | (Date) | |||
| _______________________________________ | ||||
| (Type or print declarant‘s full name) | ||||
| _______________________________________ | _______________ | |||
| (Signature of person who signed for declarant, if applicable) | (Date) | |||
| _______________________________________ | ||||
| (Type or print full name) | ||||
| B. PATIENT ADVOCATE CONSENT | ||||
| I authorize that in the event the declarant’s heart and breathing should stop, no person shall attempt to resuscitate the declarant. I understand the full import of this order and assume responsibility for its execution. This order will remain in effect until it is revoked as provided by law. | ||||
| _______________________________________ | _______________ | |||
| (Patient advocate’s signature) | (Date) | |||
| _______________________________________ | ||||
| (Type or print patient advocate‘s name) | ||||
| ATTESTATION OF WITNESSES | ||||
| The individual who has executed this order appears to be of sound mind, and under no duress, fraud, or undue influence. Upon executing this order, the declarant has (has not) received an identification bracelet. | ||||
| ______________________________ | ______________________________ | |||
| (Witness signature) (Date) | (Witness signature) (Date) | |||
| ______________________________ | ______________________________ | |||
| (Type or print witness’s name) | (Type or print witness’s name) | |||
| THIS FORM WAS PREPARED PURSUANT TO, AND IS IN COMPLIANCE WITH, THE MICHIGAN DO-NOT-RESUSCITATE PROCEDURE ACT.”. | ||||