Maryland: Living Will and Advance Health-Care Instruction Requirements

Maryland calls the adult's treatment instruction Part II: Treatment
Preferences (Living Will) of an advance directive. Part I appoints a health
care agent and is outside this page's scope. Section 5-603 expressly allows
the adult to complete only Part II, and the statutory form is optional.

Requirements one by one

Maryland supports four formal communication routes

Under § 5-602, an ordinary written or electronic directive must be dated,
signed by the adult or at the adult's express direction, and subscribed by two
witnesses in the adult's physical or electronic presence. A recognized
electronic-directive service creates a narrower exception: the State-designated
exchange may accept a dated, unwitnessed video file stored by that service.

An oral directive has the same effect as a written one only when made before
the attending physician, physician assistant, or nurse practitioner and one
witness. Its substance must enter the medical record in documentation dated and
signed by the clinician and witness. Section 5-602(a)(2) separately says that,
when no validly executed or witnessed directive exists, an authentic expression
of the competent person's wishes must be considered; that sentence does not call
the expression a formally executed directive.

The witness rules do not use a notary substitute

The two witnesses may include a facility employee or the treating clinician if
acting in good faith. The named health care agent cannot witness, and at least
one witness must not knowingly inherit from the adult or receive a financial
benefit because of the adult's death. The § 5-603 form states directly that
Maryland does not require notarization.

The witnessed-video exception and the oral route have their own formalities.
Adding a notary block to a written form does not replace the two witnesses that
§ 5-602(c)(1) requires.

Incapacity and the medical condition are separate findings

Unless the document provides otherwise, § 5-602(e) makes the directive
effective after written incapacity certification by the attending physician and
a second physician. Section 5-606(a) supplies the treatment-stage procedure:
the attending physician and a second physician or nurse practitioner certify
incapacity after personal examination, with one examination within two hours.
If the patient is unconscious or cannot communicate by any means, the second
certification is excused.

Withholding or withdrawing a life-sustaining procedure under a directive that
does not appoint an agent requires another condition finding. The attending
physician and a second physician or nurse practitioner must certify a terminal
or end-stage condition. A persistent vegetative state requires two physicians,
one with the specified expertise in cognitive-function evaluation.

Treatment, tube feeding, and pain relief remain separate choices

The optional § 5-603 form repeats the same three choices for terminal
condition, persistent vegetative state, and end-stage condition. The adult may
choose no life-extending interventions and no tube nutrition or fluids; no
life-extending interventions but continued tube nutrition and fluids; or
available interventions plus tube nutrition and fluids.

The form separately addresses pain relief and lets the adult choose whether the
stated preferences guide later decision makers flexibly or must be followed
exactly. Section 5-601(p) defines life-sustaining procedures to include
artificially administered hydration and nutrition and CPR. Section 5-611(d)
still requires reasonable efforts to offer food and water by mouth and help the
person eat and drink voluntarily.

Pregnancy is an optional modification, not an automatic suspension

Part II of § 5-603 contains an optional pregnancy blank: “If I am pregnant,
my decision concerning life-sustaining procedures shall be modified as follows.”
The form says it remains valid if that space is left blank. The Health Care
Decisions Act does not substitute a categorical pregnancy override for the
adult's own choice.

The Act also says it does not authorize mercy killing, euthanasia, or an
affirmative or deliberate act or omission to end life beyond permitting the
natural process of dying (§ 5-611(c)).

Revocation can be written, physical, oral, or by a later directive

Section 5-604 permits revocation by a signed and dated written or electronic
document, physical cancellation or destruction, an oral statement to a health
care practitioner, or a subsequent directive. For an oral revocation, the
practitioner and a witness document its substance in the medical record. The
adult should notify people who received copies to the extent reasonably
possible.

Maryland also permits the adult to knowingly and voluntarily waive the right to
revoke some or all of the directive during a period of certified incapacity.
Recognized electronic-directive services may store directives and connect to
the State exchange under § 19-144, but § 5-615 requires public
information to make clear that electronic use is not mandatory.

A standards objection triggers review rather than silent disregard

Under § 5-612, a provider who believes an instruction to withhold or
withdraw a life-sustaining procedure conflicts with generally accepted patient-
care standards must seek advice from the facility's patient care advisory
committee or petition a court. Section 5-611 separately preserves a
physician's or physician assistant's ability to decline ethically inappropriate
or medically ineffective treatment, subject to its certification and notice
rules.

Good-faith action authorized by the subtitle receives the protections in
§ 5-609, and a properly made directive is presumed voluntary. Under
§ 5-617, Maryland recognizes a directive valid under Maryland law or the law
of the state where it was executed, while applying Maryland's limits to the
effect given to the patient's wishes.

What trips people up

• An oral directive is formal, not casual. It needs the specified clinician,
  one witness, and dated, signed medical-record documentation.
• A notarized paper still needs witnesses. Maryland's ordinary written and
  electronic route uses two witnesses; notarization is not the alternative.
• Incapacity alone does not authorize withdrawal. A no-agent directive also
  needs the terminal, end-stage, or persistent-vegetative-state certification
  that § 5-606(b) specifies.
• Tube nutrition and fluids are not bundled with every no-treatment choice.
  The statutory form offers them as a separate selection in each covered
  condition.

Common questions

May I complete the living-will part without naming an agent?

Yes. Section 5-603 says the adult may complete only Part II of the combined
form.

May another person sign for me?

Yes. For a written or electronic directive, § 5-602(c)(1) permits signing at
the adult's express direction. The two-witness requirement still applies.

Does Maryland require filing the directive in a state registry?

No. Maryland recognizes electronic services that store directives and connect
to the State exchange, but § 5-615 expressly says use of an electronic advance
directive is not required.

Will Maryland recognize a directive signed elsewhere?

Yes. Section 5-617 recognizes a directive executed under Maryland law or the
law of the execution state, and gives effect to the patient's wishes to the
extent Maryland law permits.

Statutes and sources

• Md. Code, Health-General §§ 5-601 and 5-602 — definitions; competent
  adult; written, electronic, video, and oral routes; signature, witnesses,
  effectiveness, notice, and medical-record filing. § 5-601 and
  § 5-602
  (accessed 2026-07-31).
• Md. Code, Health-General § 5-603 — optional combined form; Part II
  treatment choices, pain relief, pregnancy modification, exact effect,
  witness note, and no-notary statement. Official text
  (accessed 2026-07-31).
• Md. Code, Health-General §§ 5-604 and 5-606 — revocation, optional waiver,
  incapacity procedure, and condition certifications. § 5-604 and
  § 5-606
  (accessed 2026-07-31).
• Md. Code, Health-General §§ 5-609, 5-611, and 5-612 — immunity,
  presumption, treatment limits, food and water by mouth, and provider review.
  § 5-609,
  § 5-611, and
  § 5-612
  (accessed 2026-07-31).
• Md. Code, Health-General §§ 5-615, 5-617, and 19-144 — optional electronic
  use and recognized services; out-of-state recognition. § 5-615,
  § 5-617, and
  § 19-144
  (accessed 2026-07-31).