Advance Directives

What you should know

The Patient Self-Determination Act, passed by Congress, went into effect on December 1, 1991. This law requires health care providers to educate their patients and the community on issues related to advance directives (living wills and durable powers of attorney for health care). It requires hospitals, nursing facilities, hospices, home health agencies and HMOs certified by Medicare and Medicaid (Medical Assistance) to furnish timely information so that patients have the opportunity to express their wishes regarding the use or refusal of Medical care, including life-sustaining treatments. The federal law takes no stand on what decisions you should make. It does not require you to execute either a living will or a durable power of attorney, or other advance directives. You can change or revoke your advance directive at any time.

You have the right to decide about your health care

Adults generally have the right to decide if they want medical treatment (unless they are not competent). This right also includes decisions about treatments that extend life, such as life-support machines or feeding tubes.

Sometimes, an accident or illness takes away a person’s ability to make health care choices. But the decisions still must be made. If you are unable to make them, others will. They will decide based on your wishes, or your best interests if your wishes are unknown.

Maryland law gives you the right to make many healthcare decisions in advance. One way to do this is by using a written advance directive. For example, you can use a written advance directive to name an agent to make your health care decisions if you cannot. A written advance directive can also state your treatment preferences, especially about life sustaining procedures.

Naming a health care agent

You can name anyone to be your health care agent. The only exception is that, in general, someone who works where you are receiving care cannot be your agent. Your agent can be a family member or a friend.

You choose when your agent can decide for you—right away, if you want, or only after two doctors agree that you are not able to decide for yourself. You also choose the kinds of decisions your agent can make for you. For example, if you want, you can give your agent very broad power to decide about life-sustaining treatment. It’s up to you to decide how much power your agent will have to make health care decisions.

Pick your health care agent carefully. Make sure your agent knows what you want. Your agent will then follow your wishes, even if your friends or family members disagree.

Using an advance directive

There are many ways to use an advance directive. A living will is a type of written advance directive that states your wishes on life-sustaining treatments. It usually comes into effect when a person will die very soon from an incurable condition. It can also be used when a person is permanently unconscious (in a persistent vegetative state).

You can make a broader written advance directive for other health care issues too. For example, you can decide whether you want life-sustaining treatment if you are in an end-stage condition. An end-stage condition is an advanced, progressive and incurable condition resulting in complete physical dependency.

What happens if you do not make an advance directive?

No one can deny you health care because you do not have an advance directive. But you should know what happens legally if you do not.

Maryland law allows a surrogate to make medical decisions for you if you have not named a health care agent and are no longer able to decide on treatment issues for yourself. Then, your closest relative would be asked to make health care decisions for you. Your spouse, adult children, parents, or adult brothers and sisters, in that order, are considered your closest relatives. If these relatives are not available, another relative or a close friend can make decisions for you. A surrogate, though, might have less authority to decide about life-sustaining procedures than a health care agent.

If no one is able to act as a surrogate, a court might have to appoint a guardian to make your medical decisions. The guardian might be somebody who does not know you personally.

How do you get more information?

This summary does not cover every issue. It is not intended to give you specific advice regarding advance directives. If you have legal questions about your rights, please talk to a lawyer. Also, talk to your health care providers about medical issues involved in your care. Tell those caring for you about your decisions and give them a copy of any advance directive.

Forms are available on request from the nursing staff and the Case Facilitator assigned to your care.

Our commitment to the patient

We believe that dying is a natural part of life and that a dying person should be made as comfortable as possible. Our care and support of the dying patient reaffirms our belief in the human dignity of every individual.