Advance Directives

hat is an advance direc-

tive? An advance directive is a document that states your choices about medical treatment, and names a person and an alternate who can make those decisions for you in the event that you are unable to do so yourself. An example is if you are in a serious accident and are unconscious or cannot speak. The person you chose to be your surrogate decision-maker is commonly referred to as a medical power-of-attorney or healthcare proxy. You may also create a living will (not to be confused with a will used after death) which is also an advance directive wherein you indicate what type of medical treatment you want or don’t want at the end of life or in an emergency situation.

Who can have an advance directive? Anyone who is age 18 or older because injuries, accidents and illness can occur at any age. Once you are of legal age to make your own decisions, you can have an advance directive.

Who can make an advance directive? An advance directive can only be made by someone who is competent, and it must be made voluntarily. Note that you cannot “get power-ofattorney over someone”. Only the individual can appoint their own medical decision-maker.

Who should I appoint to be my decision-maker?

You should appoint someone you trust and know will make decisions based on your values, goals, and preferences, and will follow your wishes. It can be a family member, friend, or trusted professional (such as an attorney). Make sure you discuss your decision with that person because it shouldn’t be a surprise to the person you appoint. They should know what your wishes are and be agreeable to act in that capacity.

Who will make medical decisions for me

if I don’t have an advance directive? Your guardian, (if appointed by the court), your spouse, adult children, parents, siblings or a friend, if available. The decision-maker may or may not choose to do something that you want, and you may end up receiving more or less treatment than you would have preferred. Again, your best option is to have those choices in writing.

Does an advance directive need to be

notarized? No. According to the Maryland Attorney General’s Office, a written advance directive must be witnessed by two adults. Neither of the witnesses may be the person’s health care agent, and at least one witness must have no financial interest in your death.

What is a psychiatric advance directive? A psychiatric advance directive is a written statement that documents your preferences for future mental health treatment, and allows

RESOURCES

Maryland Attorney General Advance Directive: www.marylandattorneygeneral.gov

The People’s Law Library: www.peoples-law.org/ advance-directives

American Bar Association, Toolkit for Healthcare Advance Planning: www.americanbar.org

www.eforms.com/ power-of-attorney/ md/

Maryland State Anatomy Board: 410-547-1222

Anatomy Gifts Registry:

800-300-5433 appointment of a health care proxy to interpret those preferences during a crisis (National Resources Center on Psychiatric Advance Directives). It can include your preferred mental health providers and facilities, as well as preferred treatment medications.

Can I include organ donation in my

advance directive? Yes. There is a need for organ donation, and your age does not matter, but you must make arrangements in advance with the Maryland Anatomy Board, or a non-profit organization such as the Anatomy Gifts Registry (see the “Resources” section for contact information).

Do I need to hire an attorney to pre-

pare my advance directive? No, it is not necessary, but if you prefer to do so, an attorney experienced in estate planning or elder law is a good choice. There are websites noted in the “Resources” section and others online that offer advance directive forms and instructions on how to complete them.

What should I do with my advance directive once it has been completed?

Give a copy to your health care proxy (and alternate if you have named one), and your healthcare providers. If you live in an assisted living or nursing home, make sure they have a copy in your file or chart. You may also give copies to those individuals that are close to you.

How often should I update my advance

directive? It is a good idea to review it annually to make sure the choices you make are still in line with your beliefs or if there has been a major medical change in your condition or a decline in your health. You also want to make sure your healthcare power-of-attorney is still available, willing, and capable of acting in that capacity.