In Maryland, there are three types of advance directives stipulating whether a patient wants to remain alive by artificial means: (1) a living will, (2) durable power of attorney for health care and (3) documented discussion with a doctor. None is irrevocable.
Living will: Applies only to patients with terminal diseases whose death is imminent. Maryland residents may use the document to express their wish not to have their lives prolonged artificially, but they must add language specifying a desire not to be given food or water through tubes. Maryland law does not allow living wills for pregnant women. The document must be dated and signed in the presence of two witnesses.
The law requires witnesses to be:
* At least 18 years old.
* Not related to the patient by blood or marriage.
* Not entitled to any financial benefit from the patient's estate.
* Not responsible for the patient's medical care or employed by the institution responsible for his or her care.
Durable power of attorney for health care: Names a person who can speak for patients in any medical decision if they are so sick or injured that they cannot communicate or make a rational decision.
There is no law in Maryland defining durable power of attorney for health care, and the Court of Appeals has not issued a decision on it.
However, Attorney General J. Joseph Curran Jr. has written an opinion that a durable power of attorney is legal in Maryland.
Unlike the living will, this document can be used when a patient is in a coma and is not expected to revive.
The document can be written to indicate when it takes effect, but commonly it takes effect when two physicians, including the attending physician, certify that a patient is incapable of making a rational decision about his or her care.
Earlier documented discussion: A prior discussion with a doctor about a patient's wishes on the means to prolong life is as valid as a living will or durable power of attorney in Maryland if the doctor noted the discussion in the patient's medical chart and it is clearly applicable to his or her situation.
Forms for a living will and durable power of attorney may be obtained free by writing to:
Maryland Attorney General's Office
200 St. Paul Place
Baltimore, Md., 21202