DNR, MI-POST and Advance Directives in Michigan, Explained

Updated November 2026. Written and reviewed by the Lily Hospice clinical team.

In Michigan, three documents do three different jobs. A patient advocate designation names who decides when you cannot. A DNR order tells responders not to attempt CPR outside a hospital. A MI-POST is a doctor’s order for people expected to live a year or less that covers CPR and other treatment. Hospice helps families complete all three, and none is ever required.

Most families in metro Detroit meet these forms for the first time in a hospital hallway or at a nursing home admission desk, usually when someone is already very ill and there is no time to read carefully. The names sound alike, the forms are handed over in a bundle, and a question like “Does she have a DNR?” can feel like a judgment rather than a question. This guide takes them one at a time, in plain language, using what Michigan law actually says. It is written for the daughter, son or spouse who wants to get it right, and for the person who is ill and wants to say, clearly and in advance, what they do and do not want.

The three documents at a glance

Michigan does not have a statutory living will. What it has instead is a patient advocate designation, a do-not-resuscitate order and the MI-POST, each created by a different law for a different purpose.

• Patient advocate designation (often called a durable power of attorney for health care). A legal document in which you name a person to make medical decisions for you if you cannot. It is for every adult, healthy or ill, and it does not expire.
• Do-not-resuscitate (DNR) order. A medical order under the Michigan Do-Not-Resuscitate Procedure Act that tells paramedics, nurses and other responders not to attempt CPR if your heart and breathing stop in a setting outside a hospital. It is signed by you and your doctor.
• MI-POST (Michigan Physician Orders for Scope of Treatment). A pink-bordered doctor’s order set for adults with advanced illness or frailty who may die within a year. It records decisions about CPR and about other treatment, and emergency crews follow it when you cannot speak for yourself.

The short version: the advocate designation says who decides, the DNR order answers one question (no CPR), and the MI-POST turns a longer conversation about treatment into orders that travel with the person. A person on hospice very often has all three.

The patient advocate designation: who decides when you cannot

Under Michigan’s Estates and Protected Individuals Code, any adult of sound mind may sign a patient advocate designation naming another adult to make care, custody and medical treatment decisions on their behalf. The document must be signed and dated in front of two adult witnesses, and the law excludes a long list of people from witnessing it: the patient’s spouse, parent, child, grandchild or sibling, a presumptive heir, the named advocate, the attending physician, and an employee of the hospital, nursing home or health facility where the patient is being treated. A neighbor, a friend or a member of the hospice team who is not the attending physician is usually the practical answer.

Two features of the Michigan form surprise families. First, the advocate must sign a written acceptance before acting, so the form is not complete until the person you have chosen has signed it too. Second, the designation takes effect only when the attending physician and one other physician or licensed psychologist determine that the patient can no longer participate in treatment decisions. Until then, the patient decides, however ill they are. The patient can also revoke the designation at any time and in any way that communicates the intent to revoke.

The line that matters most on hospice is the one about treatment that could allow death. A Michigan patient advocate may decline or stop treatment that could allow the patient to die only if the patient expressed, in a clear and convincing manner, that the advocate has that authority. On most Michigan forms this is a separate statement that the patient initials. If that line is blank, the advocate’s power is narrower than families expect, and the hospice social worker will say so early rather than at a crisis. Our guide on feeding tubes, fluids and hospice shows how this plays out with one of the hardest decisions.

Because Michigan law does not recognize a living will as a binding document, written or spoken statements of your wishes still matter: they guide your advocate, and a court may consider them if there is ever a dispute. The simplest approach is to write your wishes into the designation itself and talk them through with the person you name.

The DNR order: one decision, outside the hospital

The Michigan Do-Not-Resuscitate Procedure Act creates an order directing that resuscitation not be started if a person’s heart and breathing have stopped in a setting outside a hospital: at home, in an assisted living or memory care residence, in a nursing home, in a car or at church. An adult of sound mind may execute the order for themselves. A patient advocate may execute one for a person who can no longer decide, and a guardian with medical authority may do so for a ward.

The order must be dated and signed by the patient (or the advocate or guardian), the attending physician, and two adult witnesses, at least one of whom is not the patient’s spouse, parent, child, grandchild, sibling or presumptive heir. Names are printed under each signature. A person whose religious beliefs oppose medical treatment may sign without a physician. The signed order is kept where the person lives or spends time, in a place responders will see it, and the physician places a copy in the medical record. An optional bracelet imprinted “DO-NOT-RESUSCITATE ORDER”, with the person’s name and address and the physician’s name, carries the order out of the house.

What the order does is narrow and specific. If a paramedic, EMT, nurse, physician, respiratory therapist or physician assistant finds no vital signs and sees the bracelet or has actual notice of the order, they do not attempt to resuscitate. It says nothing about oxygen, pain medication, antibiotics, a hospital stay or any other care, and it does not direct care inside a hospital, where hospitals use their own orders. The person may revoke it at any time, in any way they can communicate; an advocate or guardian revokes in writing with notice to the physician, after which every copy is marked void and the bracelet comes off. The law also says that no one may require a DNR order as a condition of insurance, admission to a facility or any service.

Forms are available from most hospices, and Lily brings one on the first visit when a family asks. Many families sign a DNR order on the same day they start hospice; some never do, and that is their right. Our page on what to do when someone dies at home in Michigan explains why having the order in the house changes what happens in the first hour after a death.

MI-POST: a doctor’s orders that travel with the person

MI-POST is Michigan’s version of the POLST form used in many states. It is a set of physician orders, printed on card stock with a pink border, for adults with advanced illness or frailty whose death within a year would not be a surprise. The diagnoses supporting it are written on the form, so it is not for healthy people planning ahead; for them, the patient advocate designation is the right tool. Nearly everyone on hospice is eligible.

The form is signed by the patient, or by the patient advocate or a court-appointed guardian if the patient has lost capacity, and by the attending physician, nurse practitioner or physician assistant. Nurses, social workers and chaplains can take part in the conversation but cannot sign the order. Section A records the CPR decision; later sections record other treatment choices, such as whether to go to the hospital, antibiotics, IV fluids and tube feeding. A person who wants CPR can still have a MI-POST that says so. Copies, faxes and digital images are all valid, and the original belongs to the patient.

Where it applies is the part families most often get wrong. MI-POST directs emergency medical services and care in settings other than acute care: home, assisted living, memory care and nursing homes. In a hospital or emergency room the hospital’s own orders govern. If responders do not know a MI-POST exists, they follow standard protocols, which means full treatment, so the form has to be where they will find it. When a facility transfers the person, it must send the MI-POST with the ambulance and to the receiving facility.

MI-POST expires one year after it is signed unless it is reaffirmed, and it must be reviewed within 30 days of a change in the attending clinician, a move to a new care setting, an unexpected change in condition or any change in the person’s decisions. The patient may revoke it by telling the attending clinician and completing a new form. If a person holds both a DNR order and a MI-POST and the two conflict, Michigan law says responders follow the most recent one. If a MI-POST and a patient advocate designation seem to conflict, the patient advocate interprets the patient’s wishes.

Which forms a person on hospice usually needs

Not everyone needs all three, and nobody at Lily will ask you to sign anything on the first visit. But a typical hospice patient in metro Detroit ends up with this set, and here is why.

• A patient advocate designation, completed and accepted, because the hospice team will one day need a decision from someone other than the patient, and because the treatment-that-could-allow-death line decides what that person is allowed to do.
• A DNR order, if the person does not want CPR, because it is the one document every paramedic in Oakland, Macomb and Wayne counties is trained to look for, and because an unexpected 911 call from a neighbor or an aide is the most common way a wish gets overridden.
• A MI-POST, when the person has preferences about more than CPR: no hospital transfer, no feeding tube, antibiotics only for comfort. It is especially useful in assisted living and nursing homes, where staff change shifts and a single signed order set answers the questions the family would otherwise be asked at 2 a.m. The hospice nurse and social worker work with the attending clinician to complete it.

The practical rule: keep the originals together in one folder near the front door or on the refrigerator, photograph every page onto the phone of the person named as advocate, and tell the family where the folder is. Our year-end checklist for family caregivers puts this on a one-afternoon list.

What families worry about most

“If we sign a DNR, will hospice stop treating her?” No. A DNR order covers one event, cardiac or respiratory arrest outside a hospital. Everything else that hospice does, from pain and breathing medication to the aide, the social worker and the nurse who answers at night, continues exactly as before.

“Dad never signed anything, and now he cannot.” If there is no patient advocate designation, Michigan law lets a court-appointed guardian, or in practice the family together with the attending physician, make decisions, but it is slower and harder, and a patient advocate cannot be created after the fact. The hospice social worker explains the options, including guardianship through the probate court of the county where the person lives. A DNR order can still be executed by a guardian, and a MI-POST by a guardian with medical authority.

“We have a living will from another state.” Michigan does not recognize a living will by statute, but the document is strong evidence of the person’s wishes and guides whoever decides. Out-of-state POLST forms may not be honored here, so a Michigan MI-POST or DNR order should be completed if the person has moved to metro Detroit.

“Can he change his mind?” Yes, at any time, in any way he can communicate. A person on hospice who decides they want CPR after all, or who wants to go to the hospital, is listened to, and the forms are voided and redone. Nothing here is permanent.

“Who should be the patient advocate?” Someone who will carry out the patient’s wishes even when they disagree with them, who can be reached at night, and who lives close enough to come. It is often not the oldest child. The designation can also name a successor if the first advocate cannot serve.

How Lily handles it in Oakland, Macomb and Wayne counties

On the first visit, the Lily nurse asks what documents already exist and reads them, because a form that is signed but not witnessed, or an advocate who never signed the acceptance, is a common finding. The social worker brings blank Michigan forms, explains each one without pressure, and can help arrange witnesses. If the person wants a DNR order or a MI-POST, Lily works with the attending physician or Lily’s medical director to complete it, usually within days, and places copies in the chart and in the home. Nothing is required: Lily cares for people who want full treatment and people who want none, in all of Oakland, Macomb and Wayne counties, at home and in facilities, and a real person answers 24 hours a day. If you are still deciding whether it is time to ask, the Is It Time guide and hospice questions answered are good places to start; the hospice glossary explains the terms you will hear. County pages: Oakland County, Macomb County and Wayne County.

Common questions

Is a DNR order required to start hospice in Michigan?

No. Michigan law says no one may require a DNR order as a condition of insurance, admission to a facility or any service, and Medicare’s hospice benefit does not require one either. Lily admits people with and without a DNR order.

What is the difference between a DNR and a MI-POST?

A Michigan DNR order answers one question: do not attempt CPR if the heart and breathing stop outside a hospital. A MI-POST is a broader set of doctor’s orders for people with advanced illness that covers CPR and other treatment such as hospital transfer, antibiotics, fluids and tube feeding, and it directs emergency crews in non-hospital settings. A person may hold both; if they conflict, responders follow the most recent.

Does Michigan have a living will?

Not as a statutory document. Michigan recognizes the patient advocate designation, in which you name a decision-maker and can write your wishes, and your written or spoken statements can be used as evidence of your wishes. A living will from elsewhere still guides your advocate.

Who can witness a patient advocate designation in Michigan?

Two adults who are not the patient’s spouse, parent, child, grandchild or sibling, not a presumptive heir, not the named advocate, not the attending physician and not an employee of the facility where the patient is being treated. A friend or neighbor is usually the simplest choice.

Does a DNR order work in a hospital?

The Michigan DNR order applies in settings outside a hospital. Hospitals use their own code-status orders, so tell the admitting team about the DNR and the patient’s wishes at every admission.

How long is a MI-POST valid?

One year from the date it was signed, unless it is reaffirmed, and it must be reviewed within 30 days of a change in the attending clinician, care setting, condition or the person’s decisions. A DNR order and a patient advocate designation do not expire.

Can the hospice nurse sign the MI-POST?

No. A physician, nurse practitioner or physician assistant responsible for the patient’s care signs it, along with the patient or their patient advocate or guardian. Hospice nurses, social workers and chaplains take part in the conversation and help get the form completed.

Where should we keep the forms?

Together, in a visible place where the person lives, with copies in the medical record and photographs on the advocate’s phone. If the person leaves home and has a DNR order or a MI-POST that declines CPR, the form or the DNR bracelet goes with them.

This guide describes Michigan law and MDHHS guidance in general terms as of November 2026. It is not legal advice; for your own situation, ask your hospice social worker, your physician or an attorney.

Hospice isn’t giving up. It’s showing up. Call (248) 955-5100. A real person answers, 24 hours a day.