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Advance Directives

Personal Choices For Your Healthcare

We each have the right and responsibility to make healthcare decisions for ourselves. There may be a time, whether from accident or illness, when you are no longer able to make important and necessary medical decisions. This is an opportunity for you to express your wishes and direct your healthcare decisions in advance - before they may be needed.

Adults (ages 18 or older) who are mentally competent have the right to make healthcare decisions in advance. Advance directives state your choices for medical treatment, especially in regard to life-sustaining procedures. You can also use advance directives to name a healthcare agent, who is any person you choose, to make your healthcare decisions if you are unable to do so. Advance Directives only apply if you are unable to make personal medical decisions, unless you indicate you want your healthcare agent's authority to begin when the document is signed. You cannot be refused medical care because you do not have advance directives.

Any time you have a healthcare need, your doctor should discuss your situation with you and obtain your consent before giving you care. Patients have the right to refuse treatment or to choose among different kinds of treatment. Patients may further leave the hospital or seek treatment and opinions from other healthcare providers. Making a responsible choice does not always mean you accept your doctor's advice, but it does mean you understand the consequences of your choice. This right to decide - to say "yes" or "no" to treatment - includes consenting to, or refusing treatments needed to sustain life.

Maryland law recognizes two ways of making healthcare decisions for the future, including decisions about treatments used to sustain life. These two ways are written and oral advance directives. Although written advance directives are not required, we encourage you to take steps now to direct any future healthcare decisions so they will reflect your wishes.

Written Advance Directives

For your convenience, we have included forms for creating written advance directives. You do not need a lawyer's assistance to execute these forms effectively, but if there is anything you do not understand you should ask your doctor, social worker, or lawyer for an explanation. You should also talk to your healthcare provider about the medical issues.

Let those who will be caring for you know what you have decided, along with your healthcare agent, family, or others close to you. You can revise these forms at any time, orally or in writing. Written advance directives have two parts in this publication and you may complete one or all of the forms included. Remember, these written directives are provided to enable you to express your healthcare choices. An optional organ donation question has been included and may be completed to reflect your choices.

Appointment of a Healthcare Agent - Part A (pages 1-2)

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. You decide how much power your agent has and when the agent can exercise that power. If you want, you can give your agent broad power to make any decision about treatment that you could make.

In addition to giving your agent's power to make decisions on your behalf, you also can use the Appointment of Healthcare Agent document to indicate what you want done in some situations. No one can predict every decision that might have to be made, but your written guidance about your wishes can help your agent. 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. Your agent cannot be an owner, operator, or employee of the healthcare facility in which you are being treated unless he or she is also a close relative.

On the form, you must indicate when you want the Appointment of Healthcare Agent document to become effective. It may become effective either immediately when you sign it, or when two physicians, including your attending physician, certify that you lack the capacity and understanding to make meaningful healthcare decisions.

Healthcare Instructions - Part B (pages 3-4)

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.

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.

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).

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;
  • signed by you (if you are unable to sign, you may ask someone to sign for you in your presence.); and
  • 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.

Under the law, it is your responsibility to notify the attending physician of the existence of the documents. Your Advance Directives may be revised or revoked at any time while you have capacity to make healthcare decisions by a written or oral statement, or by destroying or damaging the documents in a manner indicating an intention to revoke it. You should give your original document to your healthcare agent, and prepare enough copies to give to your alternate healthcare agent, your attending physician or other healthcare provider, and the hospital to place on your medical record.

Reminder Checklist

After you have completed your written Advance Directives please check that you've done the following:

  • Filled out, signed, and have witnessed Part A if you want to name a healthcare agent
  • Named a back-up healthcare agent in case your first choice is not available when needed
  • Filled out, signed, and have witnessed Part B if you want to make written healthcare instructions
  • Discussed your decisions with your healthcare agent, if you named an agent, your doctor and family members
  • Initialed statements where you were asked to make a choice on either form
  • Completed the organ donation question and/or the donor card if you wish to become a donor
  • Given copies to your healthcare agent, alternate agent, physician and hospital for your medical record


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.

For Individuals Frequently Transported by Ambulance

If you do not want ambulance personnel to try to resuscitate you in the event of cardiac or respiratory arrest, you must have an EMS Palliative Care/DNR Order signed by your private physician and be wearing the accompanying bracelet.

The EMS Palliative Care/DNR Order must be written in a particular form. Because ambulance personnel who may be called to assist have so little time to evaluate the situation and act appropriately, it is not practical to ask them to interpret documentation that may vary in form and content. For this reason a standardized state form has been developed. Contact hospital staff, your physician or the Maryland Institute for Emergency Medical Services System (MIEMSS) at 410-706-4367 to obtain information about EMS Palliative Care/DNR Orders.

Get answers to Frequently Asked Questions About Advance Directives.



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