Maryland Advance Directive: What It Covers and How to Complete One

Your Maryland Advance Directive Is Two Documents in One

Most Marylanders assume an advance directive and a living will are separate documents. They are not. Under the Maryland Health Care Decisions Act (Md. Code, Health-General § 5-601 through § 5-618), your advance directive is a single unified document with two distinct parts: Part I appoints a healthcare agent to make decisions when you cannot, and Part II records your specific treatment preferences — what most people call a "living will."

This matters because completing only one part leaves a dangerous gap. If you name an agent but skip Part II, your agent has no written guidance during a crisis. If you fill in treatment preferences but skip Part I, your family falls into the state's rigid surrogate hierarchy when disagreements arise.

What Part I (Healthcare Agent) Actually Does

Part I lets you designate one person — your healthcare agent — to make medical decisions if you lose capacity. This agent can consent to or refuse treatments, choose providers, select facilities, and even make decisions about organ donation and final disposition.

Maryland law requires two physicians to certify your incapacity in writing before your agent's authority kicks in, with at least one having examined you within two hours. There is one exception: if you initial the optional "immediate authority" clause, your agent's power starts the moment you sign, though your own decisions override theirs as long as you retain capacity.

One restriction catches many people off guard: the owner, operator, or employee of a facility where you receive care cannot serve as your healthcare agent unless they are also a close relative.

What Part II (Living Will) Covers

Part II addresses three specific clinical states — and only these three:

• Terminal condition — an incurable, irreversible state where death is imminent regardless of intervention
• Persistent vegetative state — permanent unconsciousness with no awareness of self or environment
• End-stage condition — severe, irreversible deterioration with complete physical dependency

For each state, you specify whether to receive or withhold mechanical ventilation, CPR, and artificial nutrition and hydration. Maryland requires you to physically initial next to your selected statement — checkmarks and X marks are legally insufficient and can invalidate your preferences.

The Execution Requirements That Trip People Up

A Maryland advance directive must be signed and dated by you in the presence of two adult witnesses. It does not require notarization — a common misconception that delays many families. However, the witness rules are strict:

• Your named healthcare agent (and any backup agents) cannot serve as a witness
• At least one witness must be a "disinterested party" — someone who will not knowingly inherit money or property from you and has not been named to administer your estate

Getting the witness selection wrong can invalidate the entire document during a medical crisis.

Why a Completed Advance Directive Is Not Enough

Here is the gap most families discover too late: emergency medical services cannot honor your advance directive in the field. During a cardiac or respiratory emergency, EMS clinicians must perform full resuscitation unless they see a valid MOLST (Medical Orders for Life-Sustaining Treatment) form or approved EMS/DNR bracelet. Your advance directive only guides decisions after you are admitted to a hospital and physicians formally certify incapacity.

This means completing an advance directive is step one. Step two is working with your physician to translate those preferences into an actionable MOLST order — the document EMS will actually follow.

What Happens If You Do Not Have One

Without a valid advance directive, Maryland's surrogate decision-maker hierarchy takes over: court-appointed guardian first, then spouse or registered domestic partner, then adult children, parents, adult siblings, and finally friends or other relatives who file an affidavit. If surrogates of equal rank disagree — say, two adult children split on whether to continue life support — physicians cannot withdraw care until the dispute is resolved through the hospital's ethics committee or, failing that, a costly circuit court guardianship petition.

The Maryland Advance Directive & Living Will Kit walks you through every section of the statutory form with plain-language instructions, includes the witness eligibility checklist to prevent execution errors, and provides the MOLST preparation worksheet your physician needs to create enforceable emergency orders.

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