Maryland Living Will Form (Advance Directive)

The Maryland Advanced Health Care Directive will provide the principal with the choice of specific health care treatment should a medical situation arise that means they are no longer able to themselves, this power extends as far decisions regarding ending of life. This document is created in accordance with US statutes §§5-601 to 5-618 and requires two witnesses. It is invalid if the patient is pregnant.

How to Write

Part A: Appointment Of Health Care Agent

If the principal does not want an agent they can strike through this part of the document. If they require an agent they can strike through any parts of this form they do not wish to apply.

 

The Agent

The principal must choose an agent and alternative agents.

  • Name of principal.
  • Address of principal.
  • Name of agents.
  • Address of agents.

Authority Of Agent

The principal must enter details to describe the specific limitations and conditions regarding the agent`s authority.

 

Pregnancy

The principal must enter details to describe the specific limitations and conditions regarding the agent`s authority should the principal be found to be pregnant.

 

Effectiveness Of Agent`s Authority

The principal must state how the agent`s authority will become effective.

  • Initial to give the agent authority at such a time that the attending physician expresses that the principal is no longer able to decide,
  • Initial to give immediate authority to the agent.
  • Date.
  • Signature of principal.
  • Signatures of witnesses.
  • Addresses of witnesses.

 

Part B: Advanced Health Care Directive

The principal must express their wishes for their medical treatment should they become unable to decide.

In a terminal state:

  • Initial to refuse all life sustaining treatment.
  • Initial to refuse life sustaining treatment but to still receive artificial hydration and nutrition.

In a vegetative state:

  • Initial to refuse all life sustaining treatment.
  • Initial to refuse life sustaining treatment but to still receive artificial hydration and nutrition.

Suffering an End-Stage condition.

  • Initial to refuse all life sustaining treatment.
  • Initial to refuse life sustaining treatment but to still receive artificial hydration and nutrition.

The principal must initial.

  • Initial not to receive pain relief if there is risk of shortening life.
  • Initial to receive all treatments and measures possible to sustain life.

 

Pregnancy

The principal must enter details of their specific wishes regarding the event of them becoming pregnant.

 

Other Conditions

The principal must enter specific details of any other conditions and limitations regarding their end of life care and treatment.

 

Signatures

The personal details of the persons involved with this document must entered.

  • Date.
  • Principal`s name.
  • Witnesses signatures.
  • Witnesses addresses.

 

Living Will (Optional)

The principal must express their wishes for their medical treatment should they become unable to decide.

In a terminal state:

  • Initial to refuse all life sustaining treatment.
  • Initial to refuse life sustaining treatment but to still receive artificial hydration and nutrition.

In a vegetative state:

  • Initial to refuse all life sustaining treatment.
  • Initial to refuse life sustaining treatment but to still receive artificial hydration and nutrition.

Suffering an End-Stage condition.

  • Initial to refuse all life sustaining treatment.
  • Initial to refuse life sustaining treatment but to still receive artificial hydration and nutrition.

 

Pregnancy

The principal must enter details of their specific wishes regarding the event of them becoming pregnant.

 

Signatures

The personal details of the persons involved with this document must entered.

  • Date.
  • Principal`s name.
  • Witnesses signatures.
  • Witnesses addresses.

 

Organ Donation

The principal must choose if they wish to make a donation of organs, tissues or body parts after death.

  • Initial to donate any organs, tissues or eyes.
  • Initial to donate specific items entered by the principal in the relevant blank field.
  • Initial to donate for transplant.
  • Initial to donate for therapy.
  • Initial to donate for research.
  • Initial to donate for medical education.
  • Initial to donate for any purpose authorized by law.

 

Principal`s and Witnesses Signatures

The principal and the witnesses must enter their personal details.

  • Date.
  • Signature of Principal.
  • Signatures of witnesses.