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Make Early Health Care Decisions

The decision to administer or withhold life-sustaining care to a terminally ill patient can be a difficult and agonizing choice for most anyone. Faced with a situation where the patient is unable to communicate their wishes, medical providers, families, and others are placed in the unenviable position of making life or death decision under what is usually a very stressful situation.

The Maryland Health Care Decisions Act was enacted nearly ten years ago to provide a method by which an individual can make their wishes regarding medical treatment known in advance. The Act also allows a person to appoint someone to make decisions regarding health care when they are unable to do so for themselves.

Two types of forms are suggested in the Act for making certain decisions about future health care. The first, called a “living Will” (not to be confused with a “Living Trust,” an altogether different legal document) allows you to make decisions about life sustaining procedures if in the future death from a terminal condition is “imminent,” or you are in a “persistent vegetative state” (which some refer to as a “coma”). The second, known as an “Advance Directive,” is a two-part form which allows you to (1) designate a “health care agent” (the person who will make decisions for you if you are unable to) and (2) make decisions about life sustaining procedures in the event of a terminal condition, persistent vegetative state, or end stage condition as well as other health care decisions.

By designating a Health Care Agent, you may authorize the person to request, receive and review any information regarding your physical and mental health, including medical and hospital records. This is particularly important in light of recent laws, which severely restrict the disclosure of such information. The Health Care Agent can also employ and discharge health care providers, and authorize admission or discharge from a hospital or other health care facility. Perhaps most importantly, the agent may consent to providing, withdrawing or withholding of health care, including life-sustaining procedures. The agent is instructed to make their decision on the basis of your wishes, or if your wishes are unknown or unclear, what your agent believes is in your best interest.

The second part of the Advance Directive allows you to make known your decisions concerning life-sustaining procedures where you are suffering from a terminal condition, are in a persistent vegetative state or have an “end-stage” condition. The law defines an end-stage condition as an advanced, progressive, irreversible condition caused by an injury, disease or illness that has caused severe and permanent deterioration, indicated by incompetence and complete physical dependency and for which treatment would be medically ineffective.

The law and accompanying forms also provide for alternative directions in the event of pregnancy. For instance, a woman suffering from an end-stage condition may want extraordinary measures performed to be kept alive until delivery of the child. Some individuals may also want to be given all available medical treatment in accordance with accepted health care standards – the form provides that option.

If you do not have a Living Will or Advance Directive, the Health Care Decisions Act establishes an order of priority among relative and others for -surrogate” decision-making. This creates the possibility of disagreements among persons with equal decision-making authority and, although the law provides a mechanism for resolving such disputes, should be avoided if at all possible.

Forms for Living Wills and Advance Directives are available at most hospitals. They can also be obtained from the Office of the Attorney General of the State of Maryland by calling 410-576-6300. The forms require two witnesses. Additionally, the person you designate as your health care agent may not be a witness and at least one of the witnesses may not be a person who may financially benefit by reason of your death. For further information about Living Wills and Advance Directives, you may wish to consult your attorney.

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