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In the event that an unexpected accident or illness takes away your ability to make health care choices, others may be obligated to make those important decisions for you. There is a way, however, to ensure that your intentions about your care will be respected by your medical caregivers-create an advance directive.
What is an Advance Directive?
Advance directives are typically written documents that convey an individual's intentions for the provision, withholding or withdrawal of life-sustaining procedures. An advance directive allows an individual to specify the conditions for a wide range of future health care decisions
The State of Maryland released a new version of the state's advance directives forms in May 2006.
Living Wills
A living will is one type of advance directive. The living will is a document that allows you to state whether you want life-sustaining procedures provided, withheld, or withdrawn if you should become either terminally ill, in a persistent vegetative state, or have an end-stage condition. An end-stage condition is an advanced, progressive, and incurable condition resulting in complete physical dependency.
Advance Directives and Health Care Agents
Generally, an advance directive is a broad document that allows you to appoint a health care agent to act on your behalf, leave instructions for any type of medical care, or both.
Oral Advance Directives
Maryland law also allows you to make an oral advance directive to your doctor with a witness. Oral advance directives can be used to name a health care agent, to make decisions about life-sustaining procedures, or both.
Naming a Health Care Agent
You can name anyone to be your health care agent - your spouse, an adult child, other family member or a friend. The only exception is that a health care agent may not be an employee, owner or operator of a health care facility where the patient is being treated, unless the agent would also qualify as a surrogate.
You choose when your agent can decide for you. For example, your agent may be given authority to make medical decisions only after two doctors agree that you are not able to do so yourself. You can also choose the kinds of decisions your agent can make for you. For example, you can give your agent very broad or very specific powers in deciding about life-sustaining treatment.
It is important to pick your health care agent carefully. Make sure your agent knows what you want. Your agent must then follow your wishes, even if your friends or family disagree.
What Happens if You Do Not Make an Advance Directive
No one can deny you health care because you do not have an advance directive. But you should know what happens legally if you do not.
Maryland law allows a surrogate to make medical decisions for you if you have not named a health care agent and are no longer able to decide treatment issues yourself. Then, your closest relative would be asked to make health care decisions for you. If a relative is not available, a close friend can be appointed as surrogate. However, a surrogate might have less authority to decide against life-sustaining procedures than a health care agent.
If there is no one to be a surrogate, a court might have to appoint a guardian to make your medical decisions. The guardian might be someone who does not know you personally.
Surrogate Decision Making
When a patient does not have a written advance directive, we follow Maryland law regarding "surrogate" decision making, which recognizes spouses/domestic partners, adult children, parents, siblings, or friends or other relatives as surrogate decision makers. Again, Holy Cross Hospital strongly encourages everyone to have an advance directive.
If a patient has not picked a health care agent and is no longer able to make health care decisions personally, a surrogate may do so. Surrogates are listed in priority order. Individuals in a particular class may be consulted only if all individuals in the next higher class are unavailable:
- A guardian, if one has been appointed by a court
- The patient's spouse/domestic partner
- An adult child of the patient
- A parent of the patient
- An adult brother or sister of the patient
- A friend or relative who specifies in writing that he or she is a close friend of the patient and provides facts to demonstrate enough regular contact with the patient so as to confirm sufficient familiarity with the patient's activities, health and personal beliefs
Learn More About Advance Directives
Holy Cross Hospital offers information regarding advance directives to patients and the community through:
- On Your Behalf: an in-house video that airs on Channel 6 at noon and 5:30 p.m. daily.
- Advance Directive Information Line: 301-754-7390
- Education Sessions: Holy Cross Hospital has staff available to speak with church and/or community groups regarding Advance Directives. If your organization is interested, please call 301-754-7160 to arrange for a group session.
This summary does not cover every issue. If you have legal questions about your rights, please consult a lawyer. Also, talk to your health care provider about the medical issues involved in your care. Tell those caring for you about your decisions and give them a copy of any advance directives.
Consulting the Ethical Advisory Committee
Occasionally, patients, families and other members of the community will wish to consult with the Ethical Advisory Committee about specific difficult issues that have arisen or could potentially arise throughout the course of medical treatment or care received at Holy Cross. All Holy Cross patients have the right to seek counsel from the Ethical Advisory Committee about difficult ethical cases.
The Holy Cross Hospital Ethical Advisory Committee is comprised of an interdisciplinary team of health care professionals and specially trained individuals to assist patients, families and health care providers in clarifying ethically sensitive issues, identifying values and weighing all the elements and consequences of proposed personal, medical and institutional decisions.
The Ethical Advisory Committee of Holy Cross Hospital exists to advise on various ethical issues. Its advice reflects values and patterns of human response consistent with the philosophy of the Congregation of the Sisters of the Holy Cross on health care and the values of the hospital community.
The Ethical Advisory Committee examines overall ethical issues and provides guidelines to:
To consult the Ethical Advisory Committee, please call 301-754-7025.
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