Maryland: Health Care Power of Attorney Requirements

Maryland packages health care planning in one document called an advance
directive, governed by the Maryland Health Care Decisions Act at Md. Code,
Health-General §§ 5-601 to 5-618. Part I of that directive names your health care
agent — the person who makes medical decisions for you if you cannot — and Part II,
which you can leave blank, records your treatment wishes (the "living will"). You can
also name an agent in a separate document called a health care power of attorney.
This page is about executing Part I: naming the agent.

Requirements one by one

Governing law and document

The Health Care Decisions Act supplies both the rules and, at § 5-603, an
official fill-in-the-blank form titled "Maryland Advance Directive: Planning for
Future Health Care Decisions." Using that form is, in its own words, "completely
optional" — "[o]ther forms are also valid in Maryland." What matters is meeting the
execution rules below, not which form you use.

Who can sign

You must be a "competent individual," which § 5-601(f) defines as someone "at
least 18 years of age" (or a minor who has adult capacity to consent to medical
treatment under § 20-102(a)) who "has not been determined to be incapable of making
an informed decision." Under § 5-602(c)(1) the directive must be "dated, signed by
or at the express direction of the declarant" — so if you cannot physically sign,
another person may sign your name at your direction. The person you appoint as agent
must be an adult (§ 5-601(c)).

Witnesses or notary

Maryland uses two witnesses and no notary. Section 5-602(c)(1) requires the
directive to be "subscribed by two witnesses in the physical presence or electronic
presence of the declarant," and the statutory form spells out the point most people
get wrong: "Maryland law does not require this document to be notarized." A notary
block on a form is harmless surplus; the two witness signatures are what make the
appointment valid. Maryland also recognizes fully electronic directives, and even an
unwitnessed video directive if it is dated and stored by an electronic
advance-directives service the state recognizes (§ 5-602(c)(3)).

Who can't witness or serve

Maryland's witness rules are unusually permissive. Under § 5-602(c)(2), "any
competent individual may serve as a witness ... including an employee of a health
care facility, nurse practitioner, physician assistant, or physician caring for the
declarant if acting in good faith." Two limits apply: "[t]he health care agent ...
may not serve as a witness," and "[a]t least one of the witnesses must be an
individual who is not knowingly entitled to any portion of the estate of the
declarant or ... any financial benefit by reason of the death of the declarant."

Separate rules govern who may serve as your agent. Section 5-602(b)(3) bars a
facility owner, operator, or employee (or their spouse, parent, child, or sibling)
where you are receiving care from serving as agent, unless that person would qualify
as your default surrogate (i.e., is close family) or was appointed before you began
care there. And an individual "may not serve as a health care agent" if a protective
order protects you from them, or if they are your spouse and "[t]he individual and
declarant have executed a separation agreement" or "[t]he individual or declarant
has filed an application for divorce."

When the agent can act

You decide the timing. The § 5-603 form gives you two boxes: the agent's power takes
effect immediately, or only "[w]henever I am not able to make informed decisions
about my health care." Under the default incapacity route, § 5-606(a) requires
that "the attending physician and a second physician or a nurse practitioner, one of
whom shall have examined the patient within 2 hours ... certify in writing that the
patient is incapable of making an informed decision." If you are "unconscious, or
unable to communicate by any means," the second certification is not required.

Agent's powers and limits

Once in effect, your agent may make any health care decision you could make and has
priority over anyone else authorized to decide for you (§ 5-602(b)(2), (b)(4)),
guided by your wishes and, where those are unclear, your best interest (§ 5-601(e)).
The Act's outer limits: it does not "condone, authorize, or approve mercy killing or
euthanasia" (§ 5-611(c)); providers "shall make reasonable efforts to provide ... food
and water by mouth" (§ 5-611(d)); your agent may make a separate decision about
artificial (tube) nutrition and hydration (§ 5-611(e)(1)); and life-sustaining
procedures may be withheld only when the certifications in § 5-606(b) are made.

How to revoke

Revocation is easy and informal. Under § 5-604(a), you may revoke "at any time
... by a signed and dated written or electronic document, by physical cancellation or
destruction, by an oral statement to a health care practitioner or by the execution
of a subsequent directive." You can also choose the opposite — to waive your
right to revoke during a period when you have been certified incapable (§ 5-604(a)(2))
— but that is an affirmative choice, not the default. Note the divorce effect is a
disqualification, not a § 5-604 revocation: a spouse-agent simply cannot serve once a
separation agreement is signed or a divorce is filed (§ 5-602(b)(3)(ii)).

Out-of-state directives

If you signed a directive in another state, § 5-617 honors it: it "shall be
deemed to be validly executed ... if executed in compliance with the laws of Maryland
or the laws of the state where executed," and is "construed to give effect to the
patient's wishes to the extent permitted by the laws of Maryland."

What trips people up

• Do not chase a notary. For the agent appointment Maryland requires two
  witnesses, and the statutory form states outright that notarization is not required
  (§ 5-603). A directive signed before a notary but without two witnesses is not
  properly executed.
• Your agent cannot also be a witness. People often ask the person they are
  appointing to sign as a witness too. The named agent is disqualified from
  witnessing (§ 5-602(c)(2)(ii)); line up two other adults.
• At least one witness must be a non-beneficiary. A witness who inherits from you
  or benefits from your death does not count toward the required two unless the other
  witness is a disinterested person (§ 5-602(c)(2)(iii)).
• Divorce disqualifies a spouse-agent — filing is enough. You do not have to wait
  for a final decree. Once a separation agreement is signed or a divorce application
  is filed, your spouse may not serve as agent unless you reaffirm the choice
  (§ 5-602(b)(3)(ii)–(iii)).
• Two doctors, by default, must sign off before the agent acts. Unless you chose
  immediate effect, the agent's authority waits on written certification by your
  attending physician plus a second physician or nurse practitioner (§ 5-606(a)).

Common questions

Does a Maryland advance directive have to be notarized?
No. It must be signed by you (or at your direction) and by two witnesses; Maryland law
does not require notarization (§ 5-602(c)(1); § 5-603).

Can a nurse at my hospital be one of my witnesses?
Yes. Maryland lets a health care facility employee, or even the physician caring for
you, witness in good faith — just not the agent you are naming (§ 5-602(c)(2)).

When does my agent actually get to make decisions?
Whenever you chose in the document — immediately, or only after two clinicians certify
in writing that you cannot make your own informed decisions (§ 5-606(a)).

Will the directive I signed in another state be honored in Maryland?
Yes, if it was valid where you signed it or would be valid under Maryland law; Maryland
gives effect to your wishes to the extent its law permits (§ 5-617).

Statutes and sources

• Md. Code, Health-General § 5-601 — definitions: "agent" (an adult) and
  "competent individual" (18+ or adult medical-consent capacity).
  https://mgaleg.maryland.gov/mgawebsite/laws/StatuteText?article=ghg&section=5-601&enactments=false (accessed 2026-07-16)
• Md. Code, Health-General § 5-602 — execution: dated, signed, two witnesses; who
  may witness; who may not serve as agent (facility staff, protective order, spouse in
  divorce/separation).
  https://mgaleg.maryland.gov/mgawebsite/laws/StatuteText?article=ghg&section=5-602&enactments=false (accessed 2026-07-16)
• Md. Code, Health-General § 5-603 — optional statutory advance-directive form;
  "Maryland law does not require this document to be notarized."
  https://mgaleg.maryland.gov/mgawebsite/laws/StatuteText?article=ghg&section=5-603&enactments=false (accessed 2026-07-16)
• Md. Code, Health-General § 5-604 — revocation at any time; optional waiver of the
  right to revoke during certified incapacity.
  https://mgaleg.maryland.gov/mgawebsite/laws/StatuteText?article=ghg&section=5-604&enactments=false (accessed 2026-07-16)
• Md. Code, Health-General § 5-606 — certification of incapacity: attending plus a
  second physician or nurse practitioner; single certification if unconscious.
  https://mgaleg.maryland.gov/mgawebsite/laws/StatuteText?article=ghg&section=5-606&enactments=false (accessed 2026-07-16)
• Md. Code, Health-General § 5-611 — limits: no euthanasia; food and water by
  mouth; separate agent decision on artificial nutrition and hydration.
  https://mgaleg.maryland.gov/mgawebsite/laws/StatuteText?article=ghg&section=5-611&enactments=false (accessed 2026-07-16)
• Md. Code, Health-General § 5-617 — recognition of an out-of-state directive.
  https://mgaleg.maryland.gov/mgawebsite/laws/StatuteText?article=ghg&section=5-617&enactments=false (accessed 2026-07-16)