Health Care Power of Attorney Requirements in Maryland

At a glance

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)