Advance Directives

An Advance Directive is a document in which you state what you want to be done if, in the future, you cannot make your own medical decisions. Maryland law recognizes three ways of making health care decisions for the future. They are:

• Living Will – A document in which you tell your doctors, family or others concerned about your medical care, what treatment you would or would not prefer if your condition is considered terminal or a persistent vegetative state as certified by two physicians, and you are no longer competent to make a decision.
• Appointment of a Health Care Agent – This is a legal document in which you appoint a person to make decisions about your medical care if you become unable to do so.
• Discussion with Physician – You may discuss with your physician your wishes regarding medical treatment for the future. If your decision is written and witnessed in the medical record at the time it is made, it is legally effective.

What are some decisions about my medical care that I should discuss with my doctor and include in my advance directive?

You should discuss all aspects of your medical care with your doctor. When preparing an Advance Directive, it is particularly important to talk about life-prolonging treatments such as:

• Resuscitation (CPR) – treatment to restore breath or heartbeat
• Ventilator (Respirator) – a breathing machine to help you breathe if you cannot breathe on your own.
• Food and Fluids – food and water provided through tubes if you are unable to eat on your own.

No, but it is a good idea to have one so that your doctor, your family, and others know what you want if you ever become unable to make treatment decisions for yourself.

Any competent individual may serve as a witness to any advance directive, including an employee of a healthcare facility or physician caring for the declarant if acting in good faith. Hospital employees will act as a witness when other alternatives are not available. At least one of the witnesses must be an individual who is not knowingly entitled to any portion of the estate of the declarant or knowingly entitled to any financial benefit by reason of the death of the declarant.

You may change or cancel your Advance Directive at any time. You may do so in writing or orally, but it is essential that those involved in your care, especially your doctor, family or hospital, are informed of any changes to ensure that your wishes are followed.

Give your doctor a copy of your Advance Directive and discuss your decisions with him/her. Also, bring another copy of your Advance Directive to the hospital at the time of your admission. You should also make your family aware of the existence of your Advance Directives.

As long as your wishes are legal and not in conflict with the policies of the UPMC Western Maryland, anyone involved in your care must follow your wishes or try to find someone who will follow your wishes.

A Living Will becomes effective only after two doctors certify your condition is terminal, your death is imminent, or you are in a persistent vegetative state without decision-making abilities. An appointment of a health care agent is effective anytime you become incompetent, i.e. lack the understanding or capacity needed to make or communicate decisions concerning your health care.

Specific laws from state to state make it advantageous to have one or the other. However, having both a living will and an appointment of a health care agent will ensure that your wishes for medical treatment are carried out.

No, a lawyer may be helpful but not necessary in preparing an Advance Directive.