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Senior couple meeting an estate planning attorney.

What would happen to you if you had a major medical emergency, and you were in a coma or vegetative state?

Unless you have already taken steps to provide legal instructions otherwise, the hospital will use all reasonable means to keep you alive – whether you want that or not.

The document that gives you the power to make this decision is the Advanced Medical Directive. People often think of this as a “living will.”

The Advance Medical Directive is really two documents in one. The first part is the Appointment of Health Care Agent. It assigns a person to make medical decisions for you. The second part is the Statement of Treatment Preferences. It sets out your instructions for end of life decisions.

If you don’t have an Advanced Medical Directive and become disabled someone will have to file a Court action to be appointed your Guardian. This means the people who should be spending time with you are spending time with lawyers and judges instead.

Guardianship proceedings can cost several thousand dollars, and they can get ugly. Court battles can start over who should be your agent, and what to do with you in your condition. Instead of you deciding who should act on your behalf, a Judge will to decide who your agent will be.

When someone comes to us to get a will, we also explain why they should also get an Advance Medical Directive. Look at the Advance Medical Directive as insurance policy against the emotional trauma you will put your family through if you don’t have one.

You hope you never get to the point where you won’t be able to make your own health care decisions.  But if you do, having an Advance Directive will make things much more simple and less traumatic for your loved ones.

Picking an Agent

Your health care agent should be someone you know and trust, who feels the same way you do about medical decisions, and preferably lives near you.

Before you appoint someone as your health care agent you should talk to them about this. We usually don’t talk much about the medical decisions we make. We are even less likely talk about how we feel about death and dying. Unfortunately, this is a necessary conversation.

Make this a detailed discussion. Try to use real life examples of health care decisions. Talk about  what you would have done in a similar situation.

Asking someone to make life and death decisions for you is one of the hardest things you can ask of someone. By talking to them now you will make sure that they will be able to do what you are asking them to do. You will be also be making sure they won’t second guess themselves on the decisions they have to make. Then pick a back up agent and do this all again.

One good idea is to write a letter now that explains your end of life wishes in plain English. This way, they have something to refer to other than their memory when making this tough decision.

Some people want to pick two agents to act jointly. While you can do this, keep in mind this can create problems. What if the they can’t agree on a decision? What if one of the two can’t be reached? Because of problems like these you may want to consider naming a captain of the ship.

When Does the Advance Directive Take Effect?

You get to choose when the Advance Medical Directive will go into effect. Some provide that it will go into effect when two doctors, one of whom is the treating doctor, certifies that the person is unable to make health care decisions for themselves. Others want it to go into effect immediately.

The latter is probably a safe decision, since nobody is going to deem you “incompetent” if you can speak and communicate your wishes.

The Statement of Treatment Preferences

The Maryland Advance Medical Directive form sets forth a series of questions that let you define the authority you are giving your health care agent. There are three different scenarios for each possible state you can find yourself in. You have to make these decisions now to guide your agent later.

Keep in mind that the medical provider is going to turn to your agent, explain the diagnosis and prognosis and ask the agent to make a decision in accordance with your wishes. The doctor doesn’t just read the Advance Directive and do what it says. This is why picking an agent who will follow your wishes is so important.

These options were created by the legislature in Annapolis. We didn’t come up with them, but we will make sure you understand them.

The standard options to choose from are:

  • I do not want any medical interventions used to try to extend my life and I do not want to receive nutrition or fluids by tube or other medical means.
  • I do not want medical interventions used to try to extend my life. If I am unable to take enough nourishment by mouth, however, I want to receive nutrition and fluids by tube or other medical means
  • Try to extend my life for as long as possible, using all available interventions that in reasonable medical judgment would prevent or delay my death. If I am unable to take enough nourishment by mouth, I want to receive nutrition and fluids by tube or other medical means.

The scenarios to consider are (a) a terminal condition where you will likely die no matter what; (b) a persistent vegetative state where you will linger for quite some time; and (c) an end stage condition where you are unlikely to recover but you may stay alive for a long period of time.

One of the reason for the choices above is that there is a big difference in those conditions, and in what the medical world can do for you in each one. In particular, you have to decide if you want to receive water and food through a tube if you cannot eat or drink yourself. We cannot answer these questions for you. You have to do some research and thinking and figure this out.


After reviewing these questions most people find they want the agent to make the same decisions in each scenario. One of the mistakes that people make who try to fill in these forms on their own is listing different answers for these scenarios. When we review these documents, we will ask them why they did this. Usually they can’t come up with a reason why they would make a different choice.

Think this through and do some research if you want to. Talk to your doctor. This is a big decision.

You also can set forth your wishes with respect to organ donation. You can decide if you want to donate for transplantation, therapy, research, medical education or all of the above.

Next you can state if you want to be buried or cremated.During the consult we will also ask if you have a Will and an Advance Medical Directive. For more on what these documents are, and why you should get them see our post  Getting Your Will Done and The Durable Power of Attorney.


Make sure your wishes are know and will be followed. Get your advance medical directive done now.

We make this process as simple as possible. Just give our office an call and schedule a free consolation. We will email you a questionnaire that will you let you choose the decisions you need to make to get this important document drafted.

Once you meet with one of our lawyers we finalize those decisions. Next we get a draft for your review.  We then have you come back to our office so we can witness you sign the Advance Medical Directive, and the other estate documents that you may have had us draft.

When you have your Advance Directive and other documents done, make sure you pull them out every year and review them as part our your Annual Financial Review.

Learn more: Discover what you need to know about wills, trusts & estates in Maryland. Click here to see our Free Legal Consumer Guide to Wills, Trusts & Estates and get answer to your questions today. Know your options. Be informed. Protect yourself.

Need to make your will? If you need a lawyer to write your Advance Medical Directive, contact us today.