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Maryland Advance Directive
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Maryland Advance Directive

How a Maryland advance directive works: name a health care agent, set living-will wishes, sign before two witnesses, plus the surrogate list and MOLST.

By Settled Editorial

In Maryland you do not need separate paperwork for a living will and a medical power of attorney. One document, called an advance directive, can do both: it can name a health care agent to speak for you when you cannot speak for yourself, and it can write down the treatment you do and do not want near the end of life. You sign it in front of two witnesses. It takes effect only after a doctor certifies you can no longer make your own health care decisions. All of this sits under the Maryland Health Care Decisions Act (Health-General Article, Title 5, Subtitle 6, starting at § 5-601).

Use this Maryland advance directive guide as a planning map, not as legal advice or a finished form. What you sign depends on your health, your family, and your wishes. A Maryland estate-planning attorney can help you build a directive that says what you mean. This page pairs with the Maryland power of attorney guide for the money side of incapacity planning, and it connects to the Maryland estate and probate directory.

What a Maryland Advance Directive Does

A Maryland advance directive is one written or electronic document that can carry two kinds of choices. The Health Care Decisions Act lets you use one part, the other, or both (Md. Health-General § 5-602).

  • Appoint a health care agent. You can name an adult you trust to make medical decisions, accept or refuse treatment, and act to carry out your wishes once a doctor finds you cannot decide for yourself. You may name a first-choice agent plus up to two backups. This is Maryland's version of a medical power of attorney. This part is Part I of the optional statutory form.
  • Set your treatment preferences. You can state what you want if you ever face a terminal condition, a persistent vegetative state, or an end-stage condition. For each, you may ask to allow a natural death, to allow a natural death while still receiving food and fluids, or to keep trying to extend life. This is the living-will part, Part II of the form.

You do not have to use both parts. Some people only name an agent. Some only write treatment preferences. Many do both in one signed document, which can also cover organ or tissue donation and funeral wishes (Md. Health-General § 5-603).

A naming point people mix up: Maryland does not use a separate "surrogate" document you fill out ahead of time. The agent you name is your chosen decision-maker. A surrogate is the person Maryland law selects later if you never named an agent, which a section below explains.

How to Sign One in Maryland

A written or electronic Maryland advance directive must be dated, signed by you (or by another person at your express direction), and subscribed by two witnesses in your physical or electronic presence (Md. Health-General § 5-602). Two rules shape who those witnesses can be:

  • Your named health care agent may not serve as a witness.
  • At least one of the two witnesses must be someone who is not knowingly entitled to any part of your estate and not in line for a financial benefit by reason of your death. The other witness can be any competent adult, including a health facility employee or a treating provider.

Maryland does not require notarization, and notarization is not offered as a substitute for the two-witness rule. Some people still have the document notarized so it travels better if they move or need care in another state, but a witnessed directive is valid without it.

You can use the optional statutory form in § 5-603, adapt it, or write your own. Using the state form is completely optional, and other forms are valid in Maryland.

Some adults are barred from serving as your agent under § 5-602. You cannot appoint:

  • An owner, operator, or employee of a health care facility that is treating you (or that person's spouse, parent, child, or sibling), unless the person would already qualify as a default surrogate or you named them before you began receiving care there.
  • A person who is the subject of a protective order in which you are the protected person.
  • Your spouse, once the two of you sign a separation agreement or either of you files for divorce, unless you affirm the appointment while still able to make the decision.

There is a narrow spoken option. A patient may make an oral advance directive in front of the attending physician, physician assistant, or nurse practitioner and one witness. The provider and the witness then write the substance of it in the medical record, signed and dated. For everyone planning ahead, the written, two-witness route is the path.

When the Directive Takes Effect

A Maryland advance directive does not switch on the moment you sign it. While you can still make your own choices, you stay in charge, and your current decisions control (Md. Health-General § 5-606).

Your agent's authority begins only after a written finding that you are incapable of making an informed decision. Your attending physician and a second physician or nurse practitioner must certify that in writing, and one of them must have examined you within 2 hours before the certification. If you are unconscious or unable to communicate by any means, the second certification is not required.

The living-will part carries an added layer. Life-sustaining treatment may be withheld or withdrawn only when you are certified incapable and one of these conditions is met (Md. Health-General §§ 5-601, 5-606):

  • Your attending physician and a second physician or nurse practitioner certify a terminal condition (an incurable condition that makes death imminent with no recovery despite treatment) or an end-stage condition (an advanced, progressive, irreversible condition marked by complete physical dependency).
  • Two physicians, one of them a neurologist, neurosurgeon, or other doctor with special training in evaluating how the brain is working, certify a persistent vegetative state (a loss of consciousness with no behavioral sign of self-awareness or awareness of surroundings).

Who Decides If You Have No Directive

If you never signed a directive and never named an agent, Maryland does not leave the choice open. State law sets a surrogate priority list. Once you are certified incapable and no agent is available to act, the right to decide passes down this order (Md. Health-General § 5-605).

PriorityWho can decide
1A guardian for you, if a court has appointed one
2Your spouse or domestic partner
3An adult child
4A parent
5An adult brother or sister
6A friend or other relative who files an affidavit showing regular contact and knowledge of your wishes

A few rules shape how the list works:

  • It applies only when you cannot decide and have no available agent.
  • A surrogate is supposed to decide based on your known wishes, and, if those are unknown, on your best interest.
  • Neither an agent nor a surrogate may authorize sterilization or treatment for a mental disorder.
  • If people in the same class disagree while you are in a hospital or a related care facility, the dispute goes to that facility's patient care advisory committee. Outside such a place, a physician may not withhold or withdraw life-sustaining treatment unless everyone in that class agrees.

The takeaway for planning: the surrogate list works, but it may put the decision with someone you would not have picked, or split it among people who disagree. Naming your own agent, and planning ahead the way the Maryland estate planning basics guide lays out, keeps that choice in your hands and can head off an adult guardianship.

Changing or Revoking Your Directive

A Maryland advance directive has no expiration date. It stays in force until you revoke it, and a later valid directive controls over an earlier one (Md. Health-General § 5-604).

You can change course in several ways:

  • Sign and date a written or electronic revocation.
  • Physically cancel or destroy the directive.
  • Say you revoke it to a health care practitioner. The practitioner and a witness then note the substance of what you said in your medical record.
  • Sign a new directive, which supersedes the old one.

One difference from many states is worth knowing. Maryland does not automatically revoke your directive when you divorce. Instead, a separated or divorcing spouse is disqualified from serving as your health care agent unless you affirm the appointment. If your marriage is ending and you want a new decision-maker, sign a fresh directive naming that person. After any change, tell your providers and your agent so no one relies on an old copy.

MOLST and DNR Orders

Two medical order forms sit alongside your directive and often get confused with it. Both are orders a clinician signs, not documents you sign on your own (Md. Health-General § 5-608).

  • MOLST. The Medical Orders for Life-Sustaining Treatment form turns your wishes into portable medical orders about resuscitation and other treatment that providers act on right away. It is a clinician's order, not an advance directive, and it travels with you between care settings.
  • EMS DNR order. A do-not-resuscitate order tells emergency responders not to attempt CPR, and it can come with an order form or a bracelet. A DNR order cannot be used to withhold measures that keep you comfortable or ease pain, and responders may not follow a DNR order if you express the wish to be resuscitated before an arrest.

A Simple Planning Sequence

Use this order as a checklist, then confirm the details with a Maryland attorney or your provider:

  1. Decide whether you want to name an agent, write treatment preferences, or do both in one document.
  2. Choose your health care agent and a backup, and ask them first.
  3. Write your care instructions, including your wishes for a terminal condition, a persistent vegetative state, or an end-stage condition.
  4. Sign the directive in front of two witnesses, keeping your agent out of that role.
  5. Give signed copies to your agent and your doctor, and consider adding it to a portable MOLST form with your clinician.
  6. Review it after any big life change, especially marriage or divorce, and replace it if your wishes change.

Pair this directive with the rest of your plan. The Maryland power of attorney guide covers who manages your money and property if you cannot, and the guide to avoiding probate in Maryland covers passing assets without a court file. For the full set of Maryland estate and probate pages, start at the Maryland directory.

This guide is general information about Maryland advance directives. Confirm anything that affects your situation with a licensed Maryland attorney or your health care provider before you sign or rely on a directive.

Sources:

It is not legal advice.

Prefer to talk it through? Connect with an estate-planning attorney

Settled Estate is not a law firm and does not give legal advice.

Information current as of July 21, 2026

Settled Estate is not a law firm, and this content is for informational purposes only and does not constitute legal advice. Probate laws and procedures in Maryland can change. Consult with a qualified attorney for advice specific to your situation. Full disclaimer.

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