Maryland's Health Care Decision Act

Maryland's Health Care Decision Act
Written by Dawn Johns, Community Relations Director for Hospice of Washington County, Inc.

Instituted into Maryland law, amended in 2007, the Health Care Decision Act was created to help people with a serious condition make their wishes known - and to give the health care professionals information that will allow them to provide the best possible care.

Assistant Attorney Jack Schwartz has been an ambassador and advocate for establishing first, the law, and second, the documents, necessary to close the gaps in the desires of an individual with a serious condition and the health care professionals treating him/her. In essence, he [the Honorable Jack Schwartz] and others are bringing down the barriers, limiting the guess work of one's wishes and eliminating confusion when one has an inability or impaired ability to express their choices for life-sustaining treatment. The common goal is optimal treatment for living at the end of life.

Advance directives, surrogate or health care agents (proxies), Life-Sustaining Treatment Option Forms and the EMS/DNR forms were all created with the intent of lessening anxiety and increasing appropriate care in the midst of a medical crisis.

So, how does one begin to understand the jargon of these health care decision-making documents?

I'm glad you asked.

In a few, extremely abbreviated sentences, I will try to introduce each of the documents. Please understand that this is merely a beginning point to heighten your awareness. Hopefully your reading this will initiate a conversation with those you love about the treatment that would or would not be important to you, should not be able to communicate.

Let's talk about:
Advance Directives - often referred to as a 'living will'. It requires the signature of the person and two witnesses, along with a date. An oral advance directive can be documented by a physician, signature of witnesses and a date. Typically, an advance directive is not a specific form, however the State of Maryland does a have prepared document that one can utilize. Any hand written document expressing one's wishes for life-sustaining treatment is acceptable. It is presumed valid and cannot be revoked by a family member.

Surrogate or health care agents - sometimes called proxies. A health care agent is an individual that has been identified in an advance directive to either make decisions for them or advocate that their decisions will be carried out, should they not be capable. Surrogates may be called upon when there is no health care agent identified. Either way, the most important thing to remember is 'having the conversation' about how one would want to live at the end of his/her life. This will enable a health care agent or surrogate honor the wishes of a family member or loved one.

Instructions on Current Life-Sustaining Treatment Options (LST Options form) - the name was amended in 2007 replacing the Patient's Plan of Care Form that was passed into law in 2004. The form was issued by the Attorney Generals' Office and meant to be used after an admission into a nursing care facility or after a change in condition of a person residing in a nursing care facility. The form addresses one's wishes regarding life-sustaining medical technology, care preferences and decisions are to be carried out daily. If a person is transferred from one facility to another, such as a hospital, the form is to accompany him/her to communicate information about their care.

EMS/DNR - actually is an abbreviation for Emergency Medical Services Do Not Resuscitate and Medical Care Order. The form is a physician order under which EMS personnel will not attempt resuscitation when the person named is in a cardiac or respiratory arrest situation. This is an essential document to have completed regarding the delivery of life-support and interventions to be delivered. The form is initiated once the physician has had conversation with the person named or if unable to communicate, conversation should occur with his/her health care agent or surrogate.

Understanding your options for optimal health care can be confusing and frustrating. Trying to make decisions in the midst of crisis only heightens that confusion and frustration. Planning for one's care well in advance is the key.

It is important to remember that any time you have the ability to change any of the documents that indicate your wishes for care. It is advised that an advance directive be reviewed yearly to make sure one's wishes are current and as one's health changes, the directive reflects decisions accordingly.

Conversation regarding one's health care is not just for those diagnosed with a life-limiting illness. A serious illness or accident can happen anytime to anyone, so why not be prepared before the crisis?

For more information regarding any of the forms discussed within, please contact the Community Relations Department at Hospice of Washington County by calling 301-791-6360. Also, downloadable forms and information may be located at, click "Health Policy".