Can a Patient Advocate be Required to Sign a DNR?
A person cannot be required to sign a DNR order in order to receive health benefits. If there is a dispute, it may be necessary to petition the court for a determination. Please see the following Michigan statutes to determine applicability:
333.1064 Requirement to execute order prohibited.
Sec. 14. A person or organization shall not require the execution of an
order described in section 3 or 5 as a condition for insurance coverage,
admittance to a health care facility, receiving health care benefits or
services, or any other reason.
333.1061 Determination by health professional.
Sec. 11. (1) One or more of the following health professionals who
arrive at a declarant's location outside of a hospital, a nursing home,
or a mental health facility owned or operated by the department of
community health shall determine if the declarant has 1 or more vital
signs, whether or not the health professional views or is provided with
an order described in section 3 or 5 that is alleged to have been signed
by the declarant or other person authorized to execute an order:
(a) A paramedic.
(b) An emergency medical technician.
(c) An emergency medical technician specialist.
(d) A physician.
(e) A nurse.
(f) A medical first responder.
(g) A respiratory therapist.
(2) If the health professional determines under subsection (1) that the
declarant has no vital signs, and if the health professional determines
that the declarant is wearing a do-not-resuscitate identification
bracelet or is provided with a do-not-resuscitate order for the
declarant, he or she shall not attempt to resuscitate the declarant.
333.1058 Copy of order as permanent medical record.
Sec. 8. An attending physician who signs a declarant's
do-not-resuscitate order under section 3 shall immediately make a copy or
obtain from the declarant a duplicate of the executed order and make that
copy or duplicate part of the declarant's permanent medical record.
333.1055 Individuals depending upon spiritual means for healing;
authority to execute do-not-resuscitate orders; form; declarants'
names, witnesses, signature; identification bracelet; possession
Sec. 5. (1) An individual who is 18 years of age or older, of sound
mind, and an adherent of a church or religious denomination whose members
depend upon spiritual means through prayer alone for healing may execute
a do-not-resuscitate order on his or her own behalf. A patient advocate
of an individual who is 18 years of age or older and an adherent of a
church or religious denomination whose members depend upon spiritual
means through prayer alone for healing may execute a do-not-resuscitate
order on behalf of that individual.
(2) An order executed under this section shall be on a form described
in section 6. The order shall be dated and executed voluntarily and
signed by each of the following persons:
(a) The declarant or another person who, at the time of the signing, is
in the presence of the declarant and acting pursuant to the directions of
(b) Two witnesses 18 years of age or older, at least 1 of whom is
not the declarant's spouse, parent, child, grandchild, sibling, or
(3) The name of the declarant and of each witness shall be printed
or typed below the corresponding signatures. A witness shall not
sign an order unless the declarant appears to the witness to be of
sound mind and under no duress, fraud, or undue influence.
(4) At any time after an order is signed and witnessed, the declarant
or an individual designated by the declarant may apply an identification
bracelet to the declarant's wrist.
(5) A declarant who executes an order under this section shall maintain
possession of the order and shall have the order accessible within his or
her place of residence or other setting outside of a hospital, a nursing
home, or a mental health facility owned or operated by the department of
As used in this act:
(a) "Attending physician" means the physician who has primary
responsibility for the treatment and care of a declarant.
(b) "Declarant" means a person who has executed a do-not-resuscitate
order or on whose behalf a do-not-resuscitate order has been executed as
provided in section 3 or 5.
(c) "Do-not-resuscitate order" means a document executed as prescribed
in section 3 or 5 directing that, in the event that a patient suffers
cessation of both spontaneous respiration and circulation in a setting
outside of a hospital, a nursing home, or a mental health facility owned
or operated by the department of community health, resuscitation will not
(d) "Do-not-resuscitate identification bracelet" or "identification
bracelet" means a wrist bracelet that meets the requirements of section 7
and is worn by the declarant while a do-not-resuscitate order is in
(e) "Emergency medical technician" means that term as defined in
section 20904 of the public health code, MCL 333.20904.
(f) "Emergency medical technician specialist" means that term as
defined in section 20904 of the public health code, MCL 333.20904.
(g) "Hospital" means that term as defined in section 20106 of the
public health code, MCL 333.20106.
(h) "Medical first responder" means that term as defined in
section 20906 of the public health code, MCL 333.20906.
(i) "Nurse" means a licensed practical nurse or a registered
professional nurse as defined in section 17201 of the public health code,
(j) "Order" means a do-not-resuscitate order.
(k) "Organization" means a company, corporation, firm, partnership,
association, trust, or other business entity or a governmental agency.
(l) "Paramedic" means that term as defined in section 20908 of the
public health code, MCL 333.20908.
(m) "Physician" means an individual licensed to engage in the practice
of medicine or the practice of osteopathic medicine and surgery pursuant
to article 15 of the public health code, MCL 333.16101 to 333.18838.
(n) "Patient advocate" means an individual designated to make medical
treatment decisions for a patient under sections 5506 to 5515 of the
estates and protected individuals code, 1998 PA 386, MCL 700.5506 to
(o) "Public health code" means 1978 PA 368, MCL 333.1101 to 333.25211.
(p) "Vital sign" means a pulse or evidence of respiration.
700.5511 Binding effect; liability of provider; exception; dispute.
(1) Irrespective of a previously expressed or evidenced desire, a
current desire by a patient to have provided, and not withheld or
withdrawn, a specific life-extending care, custody, or medical treatment
is binding on the patient advocate, if known by the patient advocate,
regardless of the then ability or inability of the patient to participate
in care, custody, or medical treatment decisions or the patient's
(2) A person providing, performing, withholding, or withdrawing care,
custody, or medical or mental health treatment as a result of the
decision of an individual who is reasonably believed to be a patient
advocate and who is reasonably believed to be acting within the authority
granted by the designation is liable in the same manner and to the same
extent as if the patient had made the decision on his or her own behalf.
(3) A person providing care, custody, or medical or mental health
treatment to a patient is bound by sound medical or, if applicable,
mental health treatment practice and by a patient advocate's instructions
if the patient advocate complies with sections 5506 to 5515, but is not
bound by the patient advocate's instructions if the patient advocate does
not comply with these sections.
(4) A mental health professional who provides mental health treatment
to a patient shall comply with the desires of the patient as expressed in
the designation. If 1 or more of the following apply to a desire of the
patient as expressed in the designation, the mental health professional is
not bound to follow that desire, but shall follow the patient's other
desires as expressed in the designation:
(a) In the opinion of the mental health professional, compliance is not
consistent with generally accepted community practice standards of
(b) The treatment requested is not reasonably available.
(c) Compliance is not consistent with applicable law.
(d) Compliance is not consistent with court-ordered treatment.
(e) In the opinion of the mental health professional, there is a
psychiatric emergency endangering the life of the patient or another
individual and compliance is not appropriate under the circumstances.
(5) If a dispute arises as to whether a patient advocate is acting
consistent with the patient's best interests or is not complying with
sections 5506 to 5515, a petition may be filed with the court in the
county in which the patient resides or is located requesting the court's
determination as to the continuation of the designation or the removal of
the patient advocate.
333.1059 Petitions for review of orders.
Sec. 9. If a person interested in the welfare of the declarant has
reason to believe that an order has been executed contrary to the
wishes of the declarant, the person may petition the probate court
to have the order and the conditions of its execution reviewed.