MARYLAND ADVANCE DIRECTIVE

(Health Care Decisions Act – Md. Code Ann., Health-Gen. § 5-601 et seq.)

TABLE OF CONTENTS

I. Document Header
II. Definitions
III. Operative Provisions
IV. Representations & Warranties
V. Covenants & Restrictions
VI. Default & Remedies
VII. Risk Allocation
VIII. Dispute Resolution
IX. General Provisions
X. Execution Block

I. DOCUMENT HEADER

1. Title; Parties.
This Advance Directive (“Directive”) is executed by [PRINCIPAL LEGAL NAME], date of birth [MM/DD/YYYY], residing at [ADDRESS] (“Declarant”).

2. Recitals.
A. Declarant is a competent individual, at least 18 years of age, acting voluntarily and free of duress.
B. Declarant intends this Directive to comply with and be interpreted under the Maryland Health Care Decisions Act, Md. Code Ann., Health-Gen. § 5-601 et seq. (“Act”).
C. Declarant desires to:
 (i) designate a health care agent;
 (ii) provide treatment instructions, including end-of-life decisions; and
 (iii) ensure that health care providers are protected when acting in good-faith reliance on this Directive.

3. Effective Date; Duration.
This Directive becomes effective on the date executed below and remains effective until revoked in accordance with Section IX.2 (Revocation).

II. DEFINITIONS

For ease of reference, defined terms appear in boldface and apply throughout this Directive:

“Act” – the Maryland Health Care Decisions Act, Md. Code Ann., Health-Gen. § 5-601 et seq.

“Advance Directive” or “Directive” – this instrument, including all attachments, amendments, and successor directives.

“Agent” – the individual(s) designated in Section III.1 to make health care decisions on Declarant’s behalf when Declarant lacks capacity.

“Attending Physician” – the physician currently responsible for Declarant’s care, as defined in Md. Code Ann., Health-Gen. § 5-601(b).

“Health Care Decision” – any consent, refusal, or withdrawal of treatment, including life-sustaining procedures, artificial nutrition or hydration, and pain management.

“Life-Sustaining Procedure” – a medical intervention that uses mechanical or other artificial means to sustain, restore, or replace a vital function and that, in the judgment of the Attending Physician, will serve only to postpone the moment of death and is otherwise futile.

“Provider” – any physician, nurse, hospital, hospice, or other person or facility providing health care services to Declarant.

[// GUIDANCE: Add additional defined terms specific to the client’s preferences, e.g., “Persistent Vegetative State,” “Terminal Condition,” etc.]

III. OPERATIVE PROVISIONS

1. Designation of Health Care Agent

1.1 Primary Agent. Declarant designates [PRIMARY AGENT FULL NAME], residing at [ADDRESS], telephone [PHONE], as primary Agent.

1.2 Successor Agents. If the primary Agent is unavailable, unwilling, or disqualified, the following, in order of priority, shall serve:
 (a) [SUCCESSOR AGENT #1 NAME & CONTACT]
 (b) [SUCCESSOR AGENT #2 NAME & CONTACT]

1.3 Authority Granted. Agent has full power to make any Health Care Decision Declarant could make, including, without limitation:
 (a) consenting to, refusing, or withdrawing treatment;
 (b) hiring and firing health care personnel;
 (c) accessing medical records compliant with 45 C.F.R. § 164.502.

1.4 Limitations. Agent’s authority is subject to the instructions set forth in Section III.2 and any other explicit limitations herein.

2. Treatment Instructions

2.1 End-of-Life Decisions. If Declarant is in a terminal condition, persistent vegetative state, or end-stage condition, and lacks capacity:
 (a) [YES/NO] – I DO / DO NOT want life-sustaining procedures.
 (b) [YES/NO] – I DO / DO NOT want artificial nutrition and hydration.
 (c) [YES/NO] – I DO / DO NOT want cardiopulmonary resuscitation (CPR).

2.2 Pain Management. Declarant desires adequate pain relief, even if it may hasten death. [YES/NO]

2.3 Organ & Tissue Donation. Upon death, Declarant [AUTHORIZES/REFUSES] organ and tissue donation for [TRANSPLANT/RESEARCH] purposes.

[// GUIDANCE: Maryland’s statutory optional form allows either “Part A – Appointment of Health Care Agent,” “Part B – Treatment Instructions,” or both. Practitioners may split or reorder these subsections accordingly.]

3. Statement of Intent

This Directive expresses Declarant’s firmly held wishes. When interpreting any ambiguity, the expressions herein control over the Agent’s discretion.

IV. REPRESENTATIONS & WARRANTIES

4.1 Declarant’s Capacity. Declarant represents that Declarant:
 (a) is at least 18 years old;
 (b) understands the nature and purpose of this Directive; and
 (c) is executing this Directive voluntarily.

4.2 Agent Eligibility. Declarant has confirmed that each Agent:
 (a) is at least 18 years old;
 (b) is not the Attending Physician or an employee of a facility currently treating Declarant (unless a relative, per Md. Code Ann., Health-Gen. § 5-602(c)(5)); and
 (c) has agreed to serve.

4.3 No Conflict. Declarant has disclosed no material conflicts of interest that would impair an Agent’s ability to act solely in Declarant’s best interest.

V. COVENANTS & RESTRICTIONS

5.1 Agent Duties. Each Agent shall:
 (a) act in good faith, consistent with Declarant’s known wishes and best interests;
 (b) consult available medical professionals; and
 (c) keep reasonably detailed records of material decisions.

5.2 Notice Obligations. Agent shall deliver a copy of this Directive to the Attending Physician and, upon request, to any Provider.

5.3 Compliance with Law. All actions under this Directive must comply with the Act and all other applicable federal and state laws.

VI. DEFAULT & REMEDIES

6.1 Unavailability of Agent. If no designated Agent is reasonably available, Providers shall follow Declarant’s instructions in Section III.2 or, if unclear, the default surrogate hierarchy under Md. Code Ann., Health-Gen. § 5-605.

6.2 Judicial Relief. Any interested person may petition the appropriate Maryland circuit court for injunctive or declaratory relief to resolve disputes or enforce this Directive.

6.3 Costs & Fees. The court may award costs, including reasonable attorneys’ fees, to the prevailing party acting in good faith.

VII. RISK ALLOCATION

7.1 Provider Protection & Indemnification.
 (a) Good-Faith Standard. No Provider acting in good-faith reliance on this Directive shall incur civil or criminal liability or be subject to disciplinary action. Md. Code Ann., Health-Gen. § 5-609(a).
 (b) Indemnification. Declarant’s estate shall indemnify and hold harmless each Provider from any claim, loss, or expense arising out of good-faith compliance with this Directive, except to the extent of Provider’s gross negligence or willful misconduct.

7.2 Limitation of Liability. In no event shall any Provider be liable for damages beyond those proximately caused by gross negligence or willful misconduct (“Good-Faith Liability Cap”).

7.3 Force Majeure. Agent and Providers shall not be liable for inability to comply with this Directive caused by acts of God, war, riot, epidemic, or other events outside reasonable control, provided reasonable efforts are made to implement Declarant’s wishes.

VIII. DISPUTE RESOLUTION

8.1 Governing Law. This Directive and all Health Care Decisions hereunder shall be governed by the laws of the State of Maryland (“state_healthcare_law”), without regard to conflict-of-laws principles.

8.2 Forum Selection. Any action arising under or relating to this Directive shall be brought exclusively in the state courts of Maryland having appropriate jurisdiction.

8.3 Arbitration & Jury Waiver. Not applicable.

8.4 Preservation of Injunctive Relief. Nothing in this Section VIII shall limit any party’s right to seek injunctive or declaratory relief to enforce health-care-related rights under this Directive.

IX. GENERAL PROVISIONS

9.1 Amendment. Declarant may amend this Directive only by a written instrument signed and witnessed in the manner required for an original Directive.

9.2 Revocation. This Directive may be revoked at any time by:
 (a) executing a subsequent written directive;
 (b) a signed and dated writing expressing intent to revoke;
 (c) physical cancellation, destruction, or obliteration of the original Directive;
 (d) an oral statement of intent to revoke made by Declarant to an Attending Physician or other health care provider, witnessed by one additional individual; or
 (e) automatic revocation of a spouse Agent upon divorce or legal separation, per Md. Code Ann., Health-Gen. § 5-604.

[// GUIDANCE: Counsel should advise clients to distribute copies of any revocation promptly to Agents and Providers.]

9.3 Severability. If any provision is held invalid, the remaining provisions shall remain in full force to the maximum extent permitted by law.

9.4 Integration. This Directive constitutes the entire statement of Declarant’s wishes concerning the subject matter hereof, superseding all prior directives to the extent of any conflict.

9.5 Electronic Copies; Counterparts. True and correct electronic or photocopied counterparts shall have the same effect as originals.

X. EXECUTION BLOCK

I understand the nature and effect of this document and sign it on the date below.

Declarant

Signature of Declarant: [NAME]
Date: [MM/DD/YYYY]

Witness Attestation

(Required: TWO adult witnesses; neither may be the primary Agent and at least one must be a non-beneficiary. Md. Code Ann., Health-Gen. § 5-602(c).)

Witness #1

I affirm that the Declarant signed or acknowledged this Directive in my presence, that I am at least 18 years old, and that I am not the Declarant’s health care Agent.

Signature: _______
Printed Name: [NAME]
Address: [ADDRESS]
Date: [MM/DD/YYYY]

Witness #2

I affirm that the Declarant signed or acknowledged this Directive in my presence, that I am at least 18 years old, and that I am neither the Declarant’s health care Agent nor knowingly entitled to any portion of the Declarant’s estate or financial benefit from the Declarant’s death.

Signature: _______
Printed Name: [NAME]
Address: [ADDRESS]
Date: [MM/DD/YYYY]

[// GUIDANCE: Notarization is optional in Maryland but may facilitate acceptance in other jurisdictions. Insert the notary acknowledgment below if desired.]

OPTIONAL NOTARY ACKNOWLEDGMENT

State of Maryland
County of [COUNTY]

On this _ day of _, 20__, before me, the undersigned Notary Public, personally appeared [DECLARANT NAME], known or satisfactorily proven to me to be the person whose name is subscribed to this instrument, and acknowledged that he/she executed the same for the purposes therein contained.

Notary Public
My Commission Expires: ______