SB-1464, As Passed House, December 9, 2004                                  

                                                                                

                                                                                

                                                                                

                                                                                

                                                                                

                                                                                

                                                                                

                                                                                

                                                                                

                                                                                

                                                                                

                           HOUSE SUBSTITUTE FOR                                 

                                                                                

                           SENATE BILL NO. 1464                                 

                                                                                

                                                                                

                                                                                

                                                                                

                                                                                

                                                                                

                                                                                

                                                                                

                                                                                

                                                                                 A bill to amend 1998 PA 386, entitled                                             

                                                                                

    "Estates and protected individuals code,"                                   

                                                                                

    by amending sections 1106, 5306, 5506, 5507, 5508, 5509, 5510,              

                                                                                

    5511, 5512, and 5520 (MCL 700.1106, 700.5306, 700.5506, 700.5507,           

                                                                                

    700.5508, 700.5509, 700.5510, 700.5511, 700.5512, and 700.5520),            

                                                                                

    sections 1106, 5506, 5507, 5508, and 5510 as amended by 2003 PA             

                                                                                

    63, section 5306 as amended and section 5520 as added by 2000 PA            

                                                                                

    312, and section 5509 as amended by 1999 PA 52, and by adding               

                                                                                

    section 5515; and to repeal acts and parts of acts.                         

                                                                                

                THE PEOPLE OF THE STATE OF MICHIGAN ENACT:                      

                                                                                

1       Sec. 1106.  As used in this act:                                            

                                                                                

2       (a) "Mental health professional" means an individual who is                 

                                                                                

3   trained and experienced in the area of mental illness or                    

                                                                                

4   developmental disabilities and who is 1 of the following:                   

                                                                                

5                                                                                (i) A physician who is licensed to practice medicine or                             

                                                                                


                                                                                

1   osteopathic medicine and surgery in this state under article 15             

                                                                                

2   of the public health code, 1978 PA 368, MCL 333.16101 to                    

                                                                                

3   333.18838.                                                                  

                                                                                

4       (ii) A psychologist licensed to practice in this state under                 

                                                                                

5   article 15 of the public health code, 1978 PA 368, MCL 333.16101            

                                                                                

6   to 333.18838.                                                               

                                                                                

7       (iii) A registered professional nurse licensed to practice in                

                                                                                

8   this state under article 15 of the public health code, 1978 PA              

                                                                                

9   368, MCL 333.16101 to 333.18838.                                            

                                                                                

10      (iv)  A  Until July 1, 2005, a social worker registered as a                 

                                                                                

11  certified social worker under article 15 of the public health               

                                                                                

12  code, 1978 PA 368, MCL 333.16101 to 333.18838.  Beginning July 1,           

                                                                                

13  2005, a licensed master's social worker licensed under article 15           

                                                                                

14  of the public health code, 1978 PA 368, MCL 333.16101 to                    

                                                                                

15  333.18838.                                                                  

                                                                                

16      (v) A physician's assistant licensed to practice in this                    

                                                                                

17  state under article 15 of the public health code, 1978 PA 368,              

                                                                                

18  MCL 333.16101 to 333.18838.                                                 

                                                                                

19      (vi) A licensed professional counselor licensed under part                   

                                                                                

20  181 of the public health code, 1978 PA 368, MCL 333.18101 to                

                                                                                

21  333.18117.                                                                  

                                                                                

22      (b) "Michigan prudent investor rule" means the fiduciary                    

                                                                                

23  investment and management rule prescribed by part 5 of this                 

                                                                                

24  article.                                                                    

                                                                                

25      (c) "Minor" means an individual who is less than 18 years of                

                                                                                

26  age.                                                                        

                                                                                

27      (d) "Minor ward" means a minor for whom a guardian is                       


                                                                                

1   appointed solely because of minority.                                       

                                                                                

2       (e) "Money" means legal tender or a note, draft, certificate                

                                                                                

3   of deposit, stock, bond, check, or credit card.                             

                                                                                

4       (f) "Mortgage" means a conveyance, agreement, or arrangement                

                                                                                

5   in which property is encumbered or used as security.                        

                                                                                

6       (g) "Nonresident decedent" means a decedent who was domiciled               

                                                                                

7   in another jurisdiction at the time of his or her death.                    

                                                                                

8       (h) "Organization" means a corporation, business trust,                     

                                                                                

9   estate, trust, partnership, joint venture, association, limited             

                                                                                

10  liability company, government, governmental subdivision or                  

                                                                                

11  agency, or another legal or commercial entity.                              

                                                                                

12      (i) "Parent" includes, but is not limited to, an individual                 

                                                                                

13  entitled to take, or who would be entitled to take, as a parent             

                                                                                

14  under this act by intestate succession from a child who dies                

                                                                                

15  without a will and whose relationship is in question.  Parent               

                                                                                

16  does not include an individual who is only a stepparent, foster             

                                                                                

17  parent, or grandparent.                                                     

                                                                                

18      (j) "Patient advocate" means an individual designated to                    

                                                                                

19  exercise powers concerning another individual's care, custody,              

                                                                                

20  and medical or mental health treatment or authorized to make an             

                                                                                

21  anatomical gift on behalf of another individual, or both, as                

                                                                                

22  provided in section 5506.                                                   

                                                                                

23      (k) "Patient advocate designation" means the written document               

                                                                                

24  executed and with the effect as described in sections 5506 to               

                                                                                

25  5512  5515.                                                                

                                                                                

26                                                                               (l) "Payor" means a trustee, insurer, business entity,                              

                                                                                

27  employer, government, governmental subdivision or agency, or                


                                                                                

1   other person authorized or obligated by law or a governing                  

                                                                                

2   instrument to make payments.                                                

                                                                                

3       (m) "Person" means an individual or an organization.                        

                                                                                

4       (n) "Personal representative" includes, but is not limited                  

                                                                                

5   to, an executor, administrator, successor personal                          

                                                                                

6   representative, and special personal representative, and any                

                                                                                

7   other person who performs substantially the same function under             

                                                                                

8   the law governing that person's status.                                     

                                                                                

9       (o) "Petition" means a written request to the court for an                  

                                                                                

10  order after notice.                                                         

                                                                                

11      (p) "Proceeding" includes an application and a petition, and                

                                                                                

12  may be an action at law or a suit in equity.  A proceeding may be           

                                                                                

13  denominated a civil action under court rules.                               

                                                                                

14      (q) "Professional conservator" means a person that provides                 

                                                                                

15  conservatorship services for a fee.  Professional conservator               

                                                                                

16  does not include a person who is an individual who is related to            

                                                                                

17  all but 2 of the protected individuals for whom he or she is                

                                                                                

18  appointed as conservator.                                                   

                                                                                

19      (r) "Professional guardian" means a person that provides                    

                                                                                

20  guardianship services for a fee.  Professional guardian does not            

                                                                                

21  include a person who is an individual who is related to all but 2           

                                                                                

22  of the wards for whom he or she is appointed as guardian.                   

                                                                                

23      (s) "Property" means anything that may be the subject of                    

                                                                                

24  ownership, and includes both real and personal property or an               

                                                                                

25  interest in real or personal property.                                      

                                                                                

26      (t) "Protected individual" means a minor or other individual                

                                                                                

27  for whom a conservator has been appointed or other protective               


                                                                                

1   order has been made as provided in part 4 of article V.                     

                                                                                

2       (u) "Protective proceeding" means a proceeding under the                    

                                                                                

3   provisions of part 4 of article V.                                          

                                                                                

4       Sec. 5306.  (1) The court may appoint a guardian if the                     

                                                                                

5   court finds by clear and convincing evidence both that the                  

                                                                                

6   individual for whom a guardian is sought is an incapacitated                

                                                                                

7   individual and that the appointment is necessary as a means of              

                                                                                

8   providing continuing care and supervision of the incapacitated              

                                                                                

9   individual, with each finding supported separately on the                   

                                                                                

10  record.  Alternately, the court may dismiss the proceeding or               

                                                                                

11  enter another appropriate order.                                            

                                                                                

12      (2) The court shall grant a guardian only those powers and                  

                                                                                

13  only for that period of time as is necessary to provide for the             

                                                                                

14  demonstrated need of the incapacitated individual.  The court               

                                                                                

15  shall design the guardianship to encourage the development of               

                                                                                

16  maximum self-reliance and independence in the individual.  If the           

                                                                                

17  court is aware that an individual has executed a patient advocate           

                                                                                

18  designation under section 5506, the court shall not grant a                 

                                                                                

19  guardian any of the same powers that are held by the patient                

                                                                                

20  advocate.  A court order establishing a guardianship shall                  

                                                                                

21  specify any limitations on the guardian's powers and any time               

                                                                                

22  limits on the guardianship.                                                 

                                                                                

23      (3) If the court finds by clear and convincing evidence that                

                                                                                

24  an individual is incapacitated and lacks the capacity to do some,           

                                                                                

25  but not all, of the tasks necessary to care for himself or                  

                                                                                

26  herself, the court may appoint a limited guardian to provide                

                                                                                

27  guardianship services to the individual, but the court shall not            


                                                                                

1   appoint a full guardian.                                                    

                                                                                

2       (4) If the court finds by clear and convincing evidence that                

                                                                                

3   the individual is incapacitated and is totally without capacity             

                                                                                

4   to care for himself or herself, the court shall specify that                

                                                                                

5   finding of fact in an order and may appoint a full guardian.                

                                                                                

6       (5) If an individual executed a patient advocate designation                

                                                                                

7   under section 5506 before the time the court determines that he             

                                                                                

8   or she became a legally incapacitated individual, a guardian does           

                                                                                

9   not have and shall not exercise the power or duty of making                 

                                                                                

10  medical or mental health treatment decisions that the patient               

                                                                                

11  advocate is designated to make.  If, however, a petition for                

                                                                                

12  guardianship or for modification under section 5310 alleges and             

                                                                                

13  the court finds that the patient advocate designation was not               

                                                                                

14  executed in compliance with section 5506, that the patient                  

                                                                                

15  advocate is not complying with the terms of the designation or              

                                                                                

16  with the applicable provisions of sections 5506 to  5512  5515,             

                                                                                

17  or that the patient advocate is not acting consistent with the              

                                                                                

18  ward's best interests, the court may modify the guardianship's              

                                                                                

19  terms to grant those powers to the guardian.                                

                                                                                

20      Sec. 5506.  (1) An individual 18 years of age or older who                  

                                                                                

21  is of sound mind at the time a patient advocate designation is              

                                                                                

22  made may designate in writing another individual who is 18 years            

                                                                                

23  of age or older to exercise powers concerning care, custody, and            

                                                                                

24  medical or mental health treatment decisions for the individual             

                                                                                

25  making the patient advocate designation.  An individual making a            

                                                                                

26  patient advocate designation under this subsection may include in           

                                                                                

27  the patient advocate designation the authority for the designated           


                                                                                

1   individual to make an anatomical gift of all or part of the                 

                                                                                

2   individual's body in accordance with this act and section 10102             

                                                                                

3   of the public health code, 1978 PA 368, MCL 333.10102.                      

                                                                                

4       (2) For purposes of this section and sections 5507 to  5512                 

                                                                                

5   5515, an individual who is named in a patient advocate                      

                                                                                

6   designation to exercise powers concerning care, custody, and                

                                                                                

7   medical or mental health treatment decisions is known as a                  

                                                                                

8   patient advocate and an individual who makes a patient advocate             

                                                                                

9   designation is known as a patient.                                          

                                                                                

10      (3) A patient advocate designation under this section must be               

                                                                                

11  in writing, signed, witnessed as provided in subsection (4),                

                                                                                

12  dated, executed voluntarily, and, before its implementation, made           

                                                                                

13  part of the patient's medical record with, as applicable, the               

                                                                                

14  patient's attending physician,  and, if applicable, with  the               

                                                                                

15  mental health professional providing treatment to the patient,              

                                                                                

16  the facility where the patient is located, or the community                 

                                                                                

17  mental health services program or hospital that is providing                

                                                                                

18  mental health services to the patient.  The patient advocate                

                                                                                

19  designation must include a statement that the authority conferred           

                                                                                

20  under this section is exercisable only when the patient is unable           

                                                                                

21  to participate in medical or mental health treatment decisions,             

                                                                                

22  as applicable, and, in the case of the authority to make an                 

                                                                                

23  anatomical gift as described in subsection (1), a statement that            

                                                                                

24  the authority remains exercisable after the patient's death.                

                                                                                

25      (4) A patient advocate designation under this section must be               

                                                                                

26  executed in the presence of and signed by 2 witnesses.  A witness           

                                                                                

27  under this section shall not be the patient's spouse, parent,               


                                                                                

1   child, grandchild, sibling, presumptive heir, known devisee at              

                                                                                

2   the time of the witnessing, physician, or patient advocate or an            

                                                                                

3   employee of a life or health insurance provider for the patient,            

                                                                                

4   of a health facility that is treating the patient, or of a home             

                                                                                

5   for the aged as defined in section 20106 of the public health               

                                                                                

6   code, 1978 PA 368, MCL 333.20106, where the patient resides, or             

                                                                                

7   of a community mental health services program or hospital that is           

                                                                                

8   providing mental health services to the patient.  A witness shall           

                                                                                

9   not sign the patient advocate designation unless the patient                

                                                                                

10  appears to be of sound mind and under no duress, fraud, or undue            

                                                                                

11  influence.                                                                  

                                                                                

12      (5) As used in this section, "community mental health                       

                                                                                

13  services program or hospital" means a community mental health               

                                                                                

14  services program as that term is defined in section 100a of the             

                                                                                

15  mental health code, 1974 PA 258, MCL 330.1100a, or a hospital as            

                                                                                

16  that term is defined in section 100b of the mental health code,             

                                                                                

17  1974 PA 258, MCL 330.1100b.                                                 

                                                                                

18      Sec. 5507.  (1) A patient advocate designation may include a                

                                                                                

19  statement of the patient's desires on care, custody, and medical            

                                                                                

20  treatment or mental health treatment, or both.  A patient                   

                                                                                

21  advocate designation may also include a statement of the                    

                                                                                

22  patient's desires on the making of an anatomical gift of all or             

                                                                                

23  part of the patient's body under part 101 of the public health              

                                                                                

24  code, 1978 PA 368, MCL 333.10101 to 333.10109.  The patient may             

                                                                                

25  authorize the patient advocate to exercise 1 or more powers                 

                                                                                

26  concerning the patient's care, custody,  and  medical treatment,            

                                                                                

27  or concerning  mental health treatment, or the making of an                


                                                                                

1   anatomical gift that the patient could have exercised on his or             

                                                                                

2   her own behalf.                                                             

                                                                                

3       (2) A patient may designate in the patient advocate                         

                                                                                

4   designation a successor individual as a patient advocate who may            

                                                                                

5   exercise powers concerning care, custody, and medical or mental             

                                                                                

6   health treatment decisions or concerning the making of an                   

                                                                                

7   anatomical gift for the patient if the first individual named as            

                                                                                

8   patient advocate does not accept, is incapacitated, resigns, or             

                                                                                

9   is removed.                                                                 

                                                                                

10      (3) Before a patient advocate designation is implemented, a                 

                                                                                

11  copy of the patient advocate designation must be given to the               

                                                                                

12  proposed patient advocate and must be given to a successor                  

                                                                                

13  patient advocate before the successor acts as patient advocate.             

                                                                                

14  Before acting as a patient advocate, the proposed patient                   

                                                                                

15  advocate must sign an acceptance of the patient advocate                    

                                                                                

16  designation.                                                                

                                                                                

17      (4) The acceptance of a designation as a patient advocate                   

                                                                                

18  must include substantially all of the following statements:                 

                                                                                

19                                                                               1.  This patient advocate designation is not effective unless                       

                                                                                

20  the patient is unable to participate in  medical treatment                  

                                                                                

21  decisions regarding the patient's medical or mental health, as              

                                                                                

22  applicable.  If this patient advocate designation includes the              

                                                                                

23  authority to make an anatomical gift as described in section                

                                                                                

24  5506, the authority remains exercisable after the patient's                 

                                                                                

25  death.                                                                      

                                                                                

26                                                                               2.  A patient advocate shall not exercise powers concerning                         

                                                                                

27  the patient's care, custody, and medical or mental health                   


                                                                                

1   treatment that the patient, if the patient were able to                     

                                                                                

2   participate in the decision, could not have exercised on his or             

                                                                                

3   her own behalf.                                                             

                                                                                

4                                                                                3.  This patient advocate designation cannot be used to make                        

                                                                                

5   a medical treatment decision to withhold or withdraw treatment              

                                                                                

6   from a patient who is pregnant that would result in the pregnant            

                                                                                

7   patient's death.                                                            

                                                                                

8                                                                                4.  A patient advocate may make a decision to withhold or                           

                                                                                

9   withdraw treatment that would allow a patient to die only if the            

                                                                                

10  patient has expressed in a clear and convincing manner that the             

                                                                                

11  patient advocate is authorized to make such a decision, and that            

                                                                                

12  the patient acknowledges that such a decision could or would                

                                                                                

13  allow the patient's death.                                                  

                                                                                

14                                                                               5.  A patient advocate shall not receive compensation for the                       

                                                                                

15  performance of his or her authority, rights, and                            

                                                                                

16  responsibilities, but a patient advocate may be reimbursed for              

                                                                                

17  actual and necessary expenses incurred in the performance of his            

                                                                                

18  or her authority, rights, and responsibilities.                             

                                                                                

19                                                                               6.  A patient advocate shall act in accordance with the                             

                                                                                

20  standards of care applicable to fiduciaries when acting for the             

                                                                                

21  patient and shall act consistent with the patient's best                    

                                                                                

22  interests.  The known desires of the patient expressed or                   

                                                                                

23  evidenced while the patient is able to participate in medical or            

                                                                                

24  mental health treatment decisions are presumed to be in the                 

                                                                                

25  patient's best interests.                                                   

                                                                                

26                                                                               7.  A patient may revoke his or her patient advocate                                

                                                                                

27  designation at any time and in any manner sufficient to                     


                                                                                

1   communicate an intent to revoke.                                            

                                                                                

2                                                                                8.  A patient may waive his or her right to revoke the                              

                                                                                

3   patient advocate designation as to the power to make mental                 

                                                                                

4   health treatment decisions, and if such a waiver is made, his or            

                                                                                

5   her ability to revoke as to certain treatment will be delayed for           

                                                                                

6   30 days after the patient communicates his or her intent to                 

                                                                                

7   revoke.                                                                     

                                                                                

8                                                                                9.  8.  A patient advocate may revoke his or her acceptance                         

                                                                                

9   of the patient advocate designation at any time and in any manner           

                                                                                

10  sufficient to communicate an intent to revoke.                              

                                                                                

11      10.  9.  A patient admitted to a health facility or agency                  

                                                                                

12  has the rights enumerated in section 20201 of the public health             

                                                                                

13  code, 1978 PA 368, MCL 333.20201.                                           

                                                                                

14      Sec. 5508.  (1) Except as provided under subsection (3), the                

                                                                                

15  authority under a patient advocate designation is exercisable by            

                                                                                

16  a patient advocate only when the patient is unable to participate           

                                                                                

17  in medical treatment or, as applicable, mental health treatment             

                                                                                

18  decisions.  The patient's attending physician and another                   

                                                                                

19  physician or licensed psychologist shall determine upon                     

                                                                                

20  examination of the patient  when  whether the patient is unable             

                                                                                

21  to participate in medical treatment decisions, shall put the                

                                                                                

22  determination in writing, shall make the determination part of              

                                                                                

23  the patient's medical record, and shall review the determination            

                                                                                

24  not less than annually.  If the patient's religious beliefs                 

                                                                                

25  prohibit an examination and this is stated in the designation,              

                                                                                

26  the patient must indicate in the designation how  it shall be               

                                                                                

27  determined when the patient advocate exercises powers concerning            


                                                                                

1   decisions on behalf of the patient  the determination under this            

                                                                                

2   subsection shall be madeThe determination of the patient's               

                                                                                

3   ability to make mental health treatment decisions shall be made             

                                                                                

4   under section 5515.                                                         

                                                                                

5       (2) If a dispute arises as to whether the patient is unable                 

                                                                                

6   to participate in medical or mental health treatment decisions, a           

                                                                                

7   petition may be filed with the court in the county in which the             

                                                                                

8   patient resides or is  found  located requesting the court's                

                                                                                

9   determination as to whether the patient is unable to participate            

                                                                                

10  in decisions regarding medical treatment  decisions  or mental              

                                                                                

11  health treatment, as applicable.  If a petition is filed under              

                                                                                

12  this subsection, the court shall appoint a guardian ad litem to             

                                                                                

13  represent the patient for the purposes of this subsection.  The             

                                                                                

14  court shall conduct a hearing on a petition under this subsection           

                                                                                

15  as soon as possible and not later than 7 days after the court               

                                                                                

16  receives the petition.  As soon as possible and not later than 7            

                                                                                

17  days after the hearing, the court shall determine whether or not            

                                                                                

18  the patient is able to participate in decisions regarding medical           

                                                                                

19  treatment  decisions  or mental health treatment, as applicable.            

                                                                                

20  If the court determines that the patient is unable to participate           

                                                                                

21  in  medical treatment  the decisions, the patient advocate's                

                                                                                

22  authority, rights, and responsibilities are effective.  If the              

                                                                                

23  court determines that the patient is able to participate in                 

                                                                                

24  medical treatment  the decisions, the patient advocate's                   

                                                                                

25  authority, rights, and responsibilities are not effective.                  

                                                                                

26      (3) In the case of a patient advocate designation that                      

                                                                                

27  authorizes a patient advocate to make an anatomical gift of all             


                                                                                

1   or part of the patient's body, the patient advocate shall act on            

                                                                                

2   the patient's behalf in accordance with section 10102 of the                

                                                                                

3   public health code, 1978 PA 368, MCL 333.10102, and may do so               

                                                                                

4   only after the patient has been declared unable to participate in           

                                                                                

5   medical treatment decisions as provided in subsection (1) or                

                                                                                

6   declared dead by a licensed physician.  The patient advocate's              

                                                                                

7   authority to make an anatomical gift remains exercisable after              

                                                                                

8   the patient's death.                                                        

                                                                                

9       Sec. 5509.  (1) An individual designated as a patient                       

                                                                                

10  advocate has the following authority, rights, responsibilities,             

                                                                                

11  and limitations:                                                            

                                                                                

12      (a) A patient advocate shall act in accordance with the                     

                                                                                

13  standards of care applicable to fiduciaries in exercising his or            

                                                                                

14  her powers.                                                                 

                                                                                

15      (b) A patient advocate shall take reasonable steps to follow                

                                                                                

16  the desires, instructions, or guidelines given by the patient               

                                                                                

17  while the patient was able to participate in decisions regarding            

                                                                                

18  care, custody,  or  medical treatment,  decisions  or mental                

                                                                                

19  health treatment, as applicable, whether given orally or as                 

                                                                                

20  written in the designation.                                                 

                                                                                

21      (c) A patient advocate shall not exercise powers concerning                 

                                                                                

22  the patient's care, custody, and medical or mental health                   

                                                                                

23  treatment that the patient, if the patient were able to                     

                                                                                

24  participate in the decision, could not have exercised on his or             

                                                                                

25  her own behalf.                                                             

                                                                                

26      (d)  This  The designation cannot be used to make a medical                 

                                                                                

27  treatment decision to withhold or withdraw treatment from a                 


                                                                                

1   patient who is pregnant that would result in the pregnant                   

                                                                                

2   patient's death.                                                            

                                                                                

3       (e) A patient advocate may make a decision to withhold or                   

                                                                                

4   withdraw treatment that would allow a patient to die only if the            

                                                                                

5   patient has expressed in a clear and convincing manner that the             

                                                                                

6   patient advocate is authorized to make such a decision, and that            

                                                                                

7   the patient acknowledges that such a decision could or would                

                                                                                

8   allow the patient's death.                                                  

                                                                                

9       (f) A patient advocate may choose to have the patient placed                

                                                                                

10  under hospice care.                                                         

                                                                                

11      (g) A patient advocate under this section shall not delegate                

                                                                                

12  his or her powers to another individual without prior                       

                                                                                

13  authorization by the patient.                                               

                                                                                

14      (h) With regard to mental health treatment decisions, the                   

                                                                                

15  patient advocate shall only consent to the forced administration            

                                                                                

16  of medication or to inpatient hospitalization, other than                   

                                                                                

17  hospitalization as a formal voluntary patient under section 415             

                                                                                

18  of the mental health code, 1974 PA 258, MCL 330.1415, if the                

                                                                                

19  patient has expressed in a clear and convincing manner that the             

                                                                                

20  patient advocate is authorized to consent to that treatment.  If            

                                                                                

21  a patient is hospitalized as a formal voluntary patient under an            

                                                                                

22  application executed by his or her patient advocate, the patient            

                                                                                

23  retains the right to terminate the hospitalization under section            

                                                                                

24  419 of the mental health code, 1974 PA 258, MCL 330.1419.                   

                                                                                

25      (2) A patient advocate designation is suspended when the                    

                                                                                

26  patient regains the ability to participate in decisions regarding           

                                                                                

27  medical treatment  decisions  or mental health treatment, as                


                                                                                

1   applicable.  The suspension is effective as long as the patient             

                                                                                

2   is able to participate in  medical treatment  those decisions.              

                                                                                

3   If the patient subsequently is determined under section 5508 or             

                                                                                

4   5515 to be unable to participate in decisions regarding medical             

                                                                                

5   treatment  decisions  or mental health treatment, as applicable,            

                                                                                

6   the patient advocate's authority, rights, responsibilities, and             

                                                                                

7   limitations are again effective.                                            

                                                                                

8       Sec. 5510.  (1) A patient advocate designation is revoked by                

                                                                                

9   1 or more of the following:                                                 

                                                                                

10      (a) The patient's death, except that part of the patient                    

                                                                                

11  advocate designation, if any, that authorizes the patient                   

                                                                                

12  advocate to make an anatomical gift of all or part of the                   

                                                                                

13  deceased patient's body in accordance with this act and section             

                                                                                

14  10102 of the public health code, 1978 PA 368, MCL 333.10102.                

                                                                                

15      (b) An order of removal by the probate court under section                  

                                                                                

16  5511(4)  5511(5).                                                          

                                                                                

17      (c) The patient advocate's resignation or removal by the                    

                                                                                

18  court, unless a successor patient advocate has been designated.             

                                                                                

19      (d) The patient's revocation of the patient advocate                        

                                                                                

20  designation.   Even  Subject to section 5515, even if the patient           

                                                                                

21  is unable to participate in medical treatment decisions, a                  

                                                                                

22  patient may revoke a patient advocate designation at any time and           

                                                                                

23  in any manner by which he or she is able to communicate an intent           

                                                                                

24  to revoke the patient advocate designation.  If there is a                  

                                                                                

25  dispute as to the intent of the patient to revoke the patient               

                                                                                

26  advocate designation, the court may make a determination on the             

                                                                                

27  patient's intent to revoke the patient advocate designation.  If            


                                                                                

1   the revocation is not in writing, an individual who witnesses a             

                                                                                

2   revocation of a patient advocate designation shall describe in              

                                                                                

3   writing the circumstances of the revocation, must sign the                  

                                                                                

4   writing, and shall notify, if possible, the patient advocate of             

                                                                                

5   the revocation.  If the patient's physician, mental health                  

                                                                                

6   professional, or health facility has notice of the patient's                

                                                                                

7   revocation of a patient advocate designation, the physician,                

                                                                                

8   mental health professional, or health facility shall note the               

                                                                                

9   revocation in the patient's  medical  records and bedside chart             

                                                                                

10  and  must  shall notify the patient advocate.                               

                                                                                

11      (e) A subsequent patient advocate designation that revokes                  

                                                                                

12  the prior patient advocate designation either expressly or by               

                                                                                

13  inconsistency.                                                              

                                                                                

14      (f) The occurrence of a provision for revocation contained in               

                                                                                

15  the patient advocate designation.                                           

                                                                                

16      (g) If a patient advocate designation is executed during a                  

                                                                                

17  patient's marriage naming the patient's spouse as the patient               

                                                                                

18  advocate, the patient advocate designation is suspended during              

                                                                                

19  the pendency of an action for separate maintenance, annulment, or           

                                                                                

20  divorce and is revoked upon the entry of a judgment of separate             

                                                                                

21  maintenance, annulment, or divorce, unless the patient has named            

                                                                                

22  a successor individual to serve as a patient advocate.  If a                

                                                                                

23  successor patient advocate is named, that individual acts as the            

                                                                                

24  patient advocate.                                                           

                                                                                

25      (2) The revocation of a patient advocate designation under                  

                                                                                

26  subsection (1) does not revoke or terminate the agency as to the            

                                                                                

27  patient advocate or other person who acts in good faith under the           


                                                                                

1   patient advocate designation and without actual knowledge of the            

                                                                                

2   revocation.  Unless the action is otherwise invalid or                      

                                                                                

3   unenforceable, an action taken without knowledge of the                     

                                                                                

4   revocation binds the patient and his or her heirs, devisees, and            

                                                                                

5   personal representatives.  A sworn statement executed by the                

                                                                                

6   patient advocate stating that, at the time of doing an act in               

                                                                                

7   accordance with the patient advocate designation, he or she did             

                                                                                

8   not have actual knowledge of the revocation of the patient                  

                                                                                

9   advocate designation is, in the absence of fraud, conclusive                

                                                                                

10  proof that the patient advocate did not have actual knowledge of            

                                                                                

11  the revocation at the time of the act.                                      

                                                                                

12      Sec. 5511.  (1) Irrespective of a previously expressed or                   

                                                                                

13  evidenced desire, a current desire by a patient to have provided,           

                                                                                

14  and not withheld or withdrawn, a specific life-extending care,              

                                                                                

15  custody, or medical treatment is binding on the patient advocate,           

                                                                                

16  if known by the patient advocate, regardless of the then ability            

                                                                                

17  or inability of the patient to participate in care, custody, or             

                                                                                

18  medical treatment decisions or the patient's competency.                    

                                                                                

19      (2) A person providing, performing, withholding, or                         

                                                                                

20  withdrawing care, custody, or medical or mental health treatment            

                                                                                

21  as a result of the decision of an individual who is reasonably              

                                                                                

22  believed to be a patient advocate and who is reasonably believed            

                                                                                

23  to be acting within the authority granted by the designation is             

                                                                                

24  liable in the same manner and to the same extent as if the                  

                                                                                

25  patient had made the decision on his or her own behalf.                     

                                                                                

26      (3) A person providing care, custody, or medical or mental                  

                                                                                

27  health treatment to a patient is bound by sound medical or, if              


                                                                                

1   applicable, mental health treatment practice and by a patient               

                                                                                

2   advocate's instructions if the patient advocate complies with               

                                                                                

3   sections 5506 to  5512  5515, but is not bound by the patient               

                                                                                

4   advocate's instructions if the patient advocate does not comply             

                                                                                

5   with these sections.                                                        

                                                                                

6       (4) A mental health professional who provides mental health                 

                                                                                

7   treatment to a patient shall comply with the desires of the                 

                                                                                

8   patient as expressed in the designation.  If 1 or more of the               

                                                                                

9   following apply to a desire of the patient as expressed in the              

                                                                                

10  designation, the mental health professional is not bound to                 

                                                                                

11  follow that desire, but shall follow the patient's other desires            

                                                                                

12  as expressed in the designation:                                            

                                                                                

13      (a) In the opinion of the mental health professional,                       

                                                                                

14  compliance is not consistent with generally accepted community              

                                                                                

15  practice standards of treatment.                                            

                                                                                

16      (b) The treatment requested is not reasonably available.                    

                                                                                

17      (c) Compliance is not consistent with applicable law.                       

                                                                                

18      (d) Compliance is not consistent with court-ordered                         

                                                                                

19  treatment.                                                                  

                                                                                

20      (e) In the opinion of the mental health professional, there                 

                                                                                

21  is a psychiatric emergency endangering the life of the patient or           

                                                                                

22  another individual and compliance is not appropriate under the              

                                                                                

23  circumstances.                                                              

                                                                                

24      (5)  (4)  If a dispute arises as to whether a patient                       

                                                                                

25  advocate is acting consistent with the patient's best interests             

                                                                                

26  or is not complying with sections 5506 to  5512  5515, a petition           

                                                                                

27  may be filed with the court in the county in which the patient              


                                                                                

1   resides or is  found  located requesting the court's                        

                                                                                

2   determination as to the continuation of the designation or the              

                                                                                

3   removal of the patient advocate.                                            

                                                                                

4       Sec. 5512.  (1) A patient advocate cannot make a medical                    

                                                                                

5   treatment decision under the authority of or under the process              

                                                                                

6   created by this section and sections 5506 to 5511 to withhold or            

                                                                                

7   withdraw treatment from a pregnant patient that would result in             

                                                                                

8   the pregnant patient's death.                                               

                                                                                

9       (2) A health care provider shall not require a patient                      

                                                                                

10  advocate designation to be executed as a condition of providing,            

                                                                                

11  withholding, or withdrawing care, custody, or medical or mental             

                                                                                

12  health treatment.                                                           

                                                                                

13      (3) A life or health insurer shall not do any of the                        

                                                                                

14  following because of the execution or implementation of a patient           

                                                                                

15  advocate designation or because of the failure or refusal to                

                                                                                

16  execute or implement such a designation:                                    

                                                                                

17      (a) Refuse to provide or continue coverage to the patient.                  

                                                                                

18      (b) Limit the amount of coverage available to a patient.                    

                                                                                

19      (c) Charge a patient a different rate.                                      

                                                                                

20      (d) Consider the terms of an existing policy of life or                     

                                                                                

21  health insurance to have been breached or modified.                         

                                                                                

22      (e) Invoke a suicide or intentional death exemption or                      

                                                                                

23  exclusion in a policy covering the patient.                                 

                                                                                

24      (4) A patient advocate designation shall not be construed to                

                                                                                

25  condone, allow, permit, authorize, or approve suicide or                    

                                                                                

26  homicide.                                                                   

                                                                                

27      (5) Except as provided in subsections (2) and (3),  this                    


     Senate Bill No. 1464 (H-1) as amended December 9, 2004

   

1   section and  sections 5506 to  5511  5515 only apply to or affect           

                                                                                

2   an individual who has executed a patient advocate designation or            

                                                                                

3   an individual acting for or on behalf of another individual who             

                                                                                

4   has executed a patient advocate designation.                                

                                                                                

5       (6) Nothing in  this section or  sections 5506 to  5511  5515               

                                                                                

6   shall be considered to authorize or compel care, custody, or                

                                                                                

7   medical or mental health treatment decisions for a patient who              

                                                                                

8   objects on religious grounds.                                               

                                                                                

9       (7) A designation executed before the effective date of this                

                                                                                

10  section with the intent of accomplishing a similar purpose as               

                                                                                

11  this section is valid but is subject to  this section,  section             

                                                                                

12  5506(1)  ,  and sections 5507 to  5511  5515; must be in writing,           

                                                                                

13  signed, witnessed or notarized, dated, and executed voluntarily;            

                                                                                

14  and, before its implementation, must be made part of the                    

                                                                                

15  patient's medical or, as applicable, mental health treatment                

                                                                                

16  record.                                                                     

                                                                                

17      Sec. 5515.  (1) A patient may waive the right to revoke a                   

                                                                                

18  patient advocate designation as to the power to exercise mental             

                                                                                

19  health treatment decisions by making the waiver as part of the              

                                                                                

20  document containing the designation.  However, mental health                

                                                                                

21  treatment provided to a patient [who has communicated his or her intent to revoke] a designation in which the                                              

                                                                                

22  patient has waived his or her right to revoke shall not continue            

                                                                                

23  for more than 30 consecutive days, and the waiver does not affect           

                                                                                

24  the patient's rights under section 419 of the mental health code,           

                                                                                

25  1974 PA 258, MCL 330.1419.                                                  

                                                                                

26      (2) A patient advocate may exercise the power to make mental                

                                                                                

27  health treatment decisions only if a physician and a mental                 


                                                                                

1   health practitioner both certify, in writing and after                      

                                                                                

2   examination of the patient, that the patient is unable to give              

                                                                                

3   informed consent to mental health treatment.  The patient may, in           

                                                                                

4   the document containing the patient advocate designation,                   

                                                                                

5   designate a physician, a mental health practitioner, or both, to            

                                                                                

6   make the determination under this subsection.  If a physician or            

                                                                                

7   mental health practitioner designated by the patient is unable or           

                                                                                

8   unwilling to conduct the examination and make the determination             

                                                                                

9   required by this subsection within a reasonable time, the                   

                                                                                

10  examination and determination shall be made by another physician            

                                                                                

11  or mental health practitioner, as applicable.                               

                                                                                

12      Sec. 5520.  A legally incapacitated individual who has a                    

                                                                                

13  guardian with responsibility for making medical or mental health            

                                                                                

14  treatment decisions cannot then designate another individual to             

                                                                                

15  make medical or mental health treatment decisions for the legally           

                                                                                

16  incapacitated individual.                                                   

                                                                                

17      Enacting section 1.  Section 5513 of the estates and                        

                                                                                

18  protected individuals code, 1998 PA 386, MCL 700.5513, is                   

                                                                                

19  repealed.                                                                   

                                                                                

20      Enacting section 2.  This amendatory act does not take                      

                                                                                

21  effect unless all of the following bills of the 92nd Legislature            

                                                                                

22  are enacted into law:                                                       

                                                                                

23      (a) Senate Bill No. 1465.                                                   

                                                                                

24      (b) Senate Bill No. 1466.                                                   

                                                                                

25      (c) Senate Bill No. 1467.                                                   

                                                                                

26      (d) Senate Bill No. 1468.                                                   

                                                                                

27      (e) Senate Bill No. 1469.                                                   


                                                                                

1       (f) Senate Bill No. 1470.                                                   

                                                                                

2       (g) Senate Bill No. 1471.                                                   

                                                                                

3       (h) Senate Bill No. 1472.