Maryland Living Will Requirements

Maryland does not have a legally separate living-will statute. Health-General Sections 5-601 through 5-618, cited as the Health Care Decisions Act, create one optional instrument, the Advance Directive, with a treatment-preferences part the form itself labels your Living Will and an agent-designation part, sharing one execution and witness block when both are completed.

A written directive is one of three valid forms Maryland recognizes. Section 5-602 also allows an oral advance directive made before your attending physician, a physician assistant, or a nurse practitioner plus one witness and documented in your medical record, and an electronic video or file advance directive accepted unwitnessed by the state-designated health information exchange if stored through a service recognized by the Maryland Health Care Commission.

A written directive must be signed by two witnesses in your physical or electronic presence. The disqualifying test for a witness is specific: at least one witness must not be knowingly entitled to any portion of your estate or knowingly entitled to any financial benefit by reason of your death. The statute does not exclude a witness for being financially responsible for your care costs, and it does not require a signed perjury declaration.

A competent individual, defined at Section 5-601(f) as someone at least 18 years old, or a minor who has the same capacity as an adult to consent to medical treatment under Section 20-102(a), and who has not been determined incapable of making an informed decision, may make an advance directive under Section 5-601(g).

Terminal condition is defined at Section 5-601 as an incurable condition that, to a reasonable degree of medical certainty, makes death imminent despite life-sustaining procedures. Section 5-603's optional form gives you your own three-way treatment choice for this condition specifically, including its own artificial nutrition and hydration answer, separate from the persistent vegetative state and end-stage condition choices.

Persistent vegetative state is defined at Section 5-601 as a loss of consciousness with no behavioral evidence of self-awareness, with no reasonable expectation of recovery after a medically appropriate period. Section 5-603's optional form gives you a separate three-way treatment choice for this condition, including its own artificial nutrition and hydration answer, and Section 5-606 requires two physicians, one with expertise in evaluating cognitive functioning, to certify this condition before treatment is withheld absent an agent.

End-stage condition is defined at Section 5-601 as an advanced, progressive, irreversible condition causing severe permanent deterioration and complete physical dependency, for which treatment would be medically ineffective. Section 5-603's optional form gives you a separate three-way treatment choice for this condition, including its own artificial nutrition and hydration answer.

Artificial nutrition and hydration is defined at Section 5-601 as part of a life-sustaining procedure. Maryland does not use one stand-alone nutrition and hydration election. Instead, Section 5-603's optional form embeds a separate nutrition and hydration answer inside each of the three condition-specific choices, terminal condition, persistent vegetative state, and end-stage condition. Section 5-611 separately requires reasonable efforts to offer food and water by mouth and preserves a health care agent's or surrogate's own authority over nutrition and hydration decisions.

The optional statutory form's Part II, item E, lets you state that no matter what your condition, you want to be given the medicine or other treatment needed to relieve pain. Section 5-611 separately requires a health care provider to make reasonable efforts to offer food and water by mouth and bars withholding medically effective, ethically appropriate treatment.

You may revoke all or part of your advance directive, including your agent's designation, at any time through a signed and dated writing, physical cancellation or destruction, an oral statement to a health care practitioner, or a later directive. An oral revocation must be documented in your medical record. You may also knowingly and voluntarily waive your right to revoke, in whole or in part, during a period after you have been certified incapable of making an informed decision.

Section 5-602(b) also lets you name a health care agent inside the same Advance Directive, in Part I of the optional form. That is a separate function from the living-will treatment-preferences instruction covered on this page: naming an agent gives someone else decision-making authority, rather than stating your own wishes directly. For full agent-designation guidance, see Maryland Healthcare Power of Attorney.

The optional statutory form gives you a blank, optional field in Part II to write your own instructions for how your life-sustaining-treatment decision should be modified if you are pregnant. This field is not required, and Maryland's Health Care Decisions Act does not itself contain any clause that automatically suspends or modifies a directive during pregnancy. Leaving the field blank means your general treatment preferences continue to control.

Maryland's Revised Uniform Anatomical Gift Act, Estates and Trusts Code Title 4, Subtitle 5, authorizes organ and tissue donation, and the Section 5-603 optional statutory form includes its own separate organ and body donation sections you may complete alongside your treatment preferences.

Federal HIPAA regulations govern how your health care agent can be authorized to access your protected health information once the agent-designation portion of your combined directive is in effect. This authorization supports the agent-decision-maker half of your directive; it does not change or expand your own treatment-preferences instructions.

Federal law requires Medicare and Medicaid participating hospitals, nursing homes, and other facilities to inform patients in writing of their right under Maryland law to make an advance directive, including stating their own treatment preferences.

An advance directive, emergency medical services do not resuscitate order, or life-sustaining treatment order executed in another state is valid in Maryland if it complied with Maryland law or the law of the state where it was executed, and Maryland gives it effect to the extent its own law permits.

The state-designated health information exchange may accept an unwitnessed electronic video or file advance directive if it is dated and stored through an electronic advance directives service recognized by the Maryland Health Care Commission. This is Maryland's substitute for a public advance directive registry.

Maryland law does not require your advance directive to be notarized, and unlike some other states, notarization is not offered as an alternative to the two-witness signing requirement. You may notarize your document in addition to having it witnessed, but doing so does not replace or reduce the two-witness requirement.

Your religious beliefs and basic values are a factor a health care agent or surrogate weighs in determining your best interest under Section 5-601(e)(7), and a factor a surrogate specifically considers in determining your wishes under Section 5-605(c). The optional Section 5-603 form also lets you tell your agent about your religious or other beliefs and values to guide decisions the form does not otherwise cover.

Maryland lets a competent individual make an oral advance directive, stating treatment wishes or appointing an agent, without any written document at all. An oral advance directive has the same legal effect as a written one if made in the presence of your attending physician, a physician assistant, or a nurse practitioner, plus one witness, and the substance is documented, dated, and signed in your medical record by that physician, physician assistant, or nurse practitioner and the witness.