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Advance Directive

What Is an Advance Directive?

An advance directive is a legal means of stating your wishes regarding your medical treatment or naming someone to make medical decisions for you if you are unable to do so.

What Types of Advance Directives are Available?

There are two types of advance directives: those that are written in a document and those that are spoken in the presence of a witness.

Written Advance Directive (Document) 

A living will specifies what medical treatment you would or would not want in the event you are in a terminal condition or a persistent vegetative state.

The appointment of a health care agent gives authority to another person to make health care decisions for you. You may specify whether the appointment takes effect immediately or at the time you are unable to make your own decisions. The appointed health care agent has broader power to execute your wishes than can be provided under a living will, so you will want to select your agent carefully to make sure your agent knows and will follow your wishes.

Health care instructions are another form of written advance directive that can be used alone or together with the appointment of a health care agent. Health care instructions allow you to specify what treatment you want or do not want in the event you are in a terminal condition, persistent vegetative state or end-stage condition, and to express other health care decisions, such as a do not resuscitate (DNR) order.

Oral Advance Directive

You may make an oral statement to your physician in the presence of a witness, providing instructions or appointing a health care agent. This statement regarding your wishes must be recorded in your medical record by your physician and signed and dated by the physician and witness.

Can Anyone Be My Agent?

Your agent may be any competent adult except an employee, owner or operator of the health care facility where you are being treated, unless the agent would also qualify as a surrogate.

Your Right Under Maryland Law to Make Decisions Regarding Your Health Care

According to Maryland and Federal law, competent adults have the right to decide whether to accept, reject or discontinue medical treatment for themselves. This includes decisions about life-sustaining treatments, such as breathing machines and feeding tubes. Sometimes it becomes impossible for individuals to communicate their wishes regarding their health care due to conditions such as coma resulting from accident or illness. In situations such as these, others must make the health care decisions for the patient. Maryland law gives you the right to make many health care decisions in advance so that your wishes can be honored in the event you cannot make your wishes known yourself. One way to do this is by making an advance directive.

Do I Have to Have an Advance Directive?

No, you do not. However, an advance directive is a good way to make your wishes regarding your medical treatment known and to have your wishes honored.

Will My Wishes Be Honored?

In most cases there will be no problem in carrying out your wishes. However, there may be some special circumstances, such as:

  • Should a disagreement arise between equal ranking surrogates regarding your medical treatment, your physician may consult the hospital's Patient Care Advisory Committee.
  • If your physician believes that an instruction to withhold or withdraw life-sustaining procedures from a patient is inconsistent with generally accepted standards of patient care, the physician may consult the hospital's Patient Care Advisory Committee or file a petition in court.
  • A physician need not provide treatment that the physician believes to be medically ineffective or ethically inappropriate. In cases where the patient, agent or surrogate instruct that health care be given that is deemed, by the physician, to be ineffective or ethically inappropriate, the physician must inform the patient, agent or surrogate that they may request a transfer to another physician and assist, if desired, in effecting the transfer. Pending the transfer, the physician must comply with the request for treatment if failure to comply would result in the death of a patient.

Do I Have to Have a Lawyer to Make an Advance Directive?

No, you do not. However, if you have concerns about the legal effect of making an advance directive, you should consult a lawyer.

How Do I Get Started on My Advance Directive?

You should talk with your physician and your family or others close to you about your feelings regarding medical treatment and health care. You may also want to speak with a clergy member or lawyer. You can also consult your nurse about having a trained hospital representative speak with you about advance directives.

To review sample forms, choose a language below:

What Should I Do After I Have Completed an Advance Directive?

Tell your health care provider and close family or friends about your decisions and give them a copy of any advance directive. For more information or help in filling out these forms, please contact the Suburban Hospital Risk Management Department at 301-896-3920.