Advanced Directives

Advanced Directives

“It always seems too early, until it’s too late.”

Imagine that you are critically ill or seriously injured and cannot communicate. Would your loved ones know what is important to you? Would they know what medical options and interventions you would choose and which ones you would not want?

It’s Your Life, It’s Your Plan

No matter how young or old you are, one important way you can take care of yourself is to complete an Advance Directive. An Advance Directive is for everyone, not just patients facing a life-limiting illness or serious injury.

It’s what matters to you, not what’s the matter with you

By completing an Advance Directive you make your wishes known. An Advance Directive is a gift you give your loved ones so that they are confident in helping guide your medical care if you are unable to do so. It alleviates some of the fear and anxiety from an already stressful situation and allows them to make decisions about your medical treatment that you want. By choosing a healthcare agent (or surrogate), you designate the person whom you trust to carry out your wishes if you are unable.

Our commitment to patient-centered care

At Frederick Memorial Hospital, we are committed to providing the highest quality medical care and supporting you in creating your Advance Directive is one way in which we accomplish that.

Our staff provides support to you in completing your Advance Directive. An Advance Directive simply states what medical interventions you would want and which ones you would not want if you are in an end stage condition, terminal condition or persistent vegetative state – an unable to communicate your wishes.

So there’s nothing to be afraid of. We are with you every step of the way – you are not alone. For assistance in completing an advance directive, please ask for or contact a social worker or case manager at 240-566-3547.

Conversation Starter Kit

The Conversation Starter Kit is designed to help you think about what your wishes are and how to have conversations with your family about your wishes.

Adults (ages 18 or older) who are mentally competent have the right to make healthcare decisions in advance. For your convenience, we have included this form to complete your Advance Directive. There are two sections when one is completing an advance directive. It’s best to complete both but it’s not required:

Living Will or Healthcare Instructions - This part of your written advance directive asks you to state what kind of care you want to receive if you are suffering from a terminal, persistent vegetative state, or an end-stage condition and are unable to communicate your wishes. Written Healthcare Instructions allow you to say whether or not you want to receive life-sustaining treatment in each of these circumstances. A life-sustaining procedure is defined as any medical procedure, treatment, or intervention that uses mechanical or other artificial means to sustain, restore, or replace a spontaneous vital function. You may also indicate whether or not you would want to receive artificially administered sustenance (nutrition and hydration given through an IV or feeding tube).

These conditions are described below:

  • A terminal condition is an incurable condition caused by injury, disease, or illness which makes death imminent. Even if life-sustaining procedures are used when an individual is close to death, there is no reasonable expectation of recovery.
  • A persistent vegetative state is a condition in which a person is permanently unconscious, unaware of his or her environment, and is unable to interact with others. There is no reasonable expectation of recovery. A persistent vegetative state is not the same as a temporary coma.
  • An end-stage condition is a progressive condition caused by injury, disease or illness in which a person suffers severe and permanent deterioration which can be accompanied by incompetence and complete physical dependency. To a reasonable degree of medical certainty, treatment of this irreversible condition would be medically ineffective.

Healthcare Agent/Medical Power of Attorney - This part of your written advance directives is a legal document that allows you to name someone you know and trust as your agent to make healthcare decisions. Your agent must be 18 years of age or older.

Choose your healthcare agent carefully, and make sure he or she knows what you want. Your agent can then follow your wishes, even if your friends or family disagree.

In order for your Healthcare Instructions and Appointment of Healthcare Agent to be effective in Maryland, both documents must be:

  • voluntarily executed and made in writing;
  • dated and signed by you;
  • witnessed by two adults, 18 or older, one of whom will not financially benefit from your death;
  • your appointed healthcare agent cannot serve as a witness.

The Advance Care Planning Checklist is a quick reminder of things to complete in the advance directive process. The Comparison of Maryland State Forms explains the differences between the forms used in Maryland for advance care planning.

Oral Advance Directives

Adults often make healthcare decisions during discussions with their physicians. The physician describes the options and explains the pros and cons of each, but you make the final decision. For example, you might decide in this way about the use of CPR (cardiopulmonary resuscitation). An oral advance directive is legally effective and is to be honored by your healthcare providers. You must communicate your decision to your doctor in front of a witness, and your decision must be written in your medical record at the time it is made and signed by the witness. You should read what is written to make sure it reflects your wishes.

Medical Orders for Life-Sustaining Treatment (MOLST)

While the Advance Directive is for future medical treatment at the end of life, the MOLST form is for current medical treatment you wish to receive. This order form makes your treatment wishes known to health care professionals and has to be signed by a physician, nurse practitioner or physician assistant. If you do not have a Do Not Resuscitate (DNR) order on your MOLST form, medics (ambulance personnel) and other healthcare team members in Maryland must attempt resuscitation. This form does not expire and it goes where you go, to the hospital, rehab, assisted living, and back home. It consolidates important information into orders that are valid across the continuum of care. For your convenience, we have included this form to complete.