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<section article="ghg" article_name="Health - General" number="5-602" title_number="5" title_name="Death" subtitle_number="6" subtitle_name="Health Care Decisions Act">
  <level label="a">
    <level label="1">
      <text>Any competent individual may, at any time, make a written or electronic advance directive regarding the provision of health care to that individual, or the withholding or withdrawal of health care from that individual.</text>
    </level>
    <level label="2">
      <text>Notwithstanding any other provision of law, in the absence of a validly executed or witnessed advance directive, any authentic expression made by an individual while competent of the individual’s wishes regarding health care for the individual shall be considered.</text>
    </level>
  </level>
  <level label="b">
    <level label="1">
      <level label="i">
        <text>In this subsection the following words have the meanings indicated.</text>
      </level>
      <level label="ii">
        <text>“Disqualified person” means:</text>
        <level label="1">
          <text>An owner, operator, or employee of a health care facility from which the declarant is receiving health care; or</text>
        </level>
        <level label="2">
          <text>A spouse, parent, child, or sibling of an owner, operator, or employee of a health care facility from which the declarant is receiving health care.</text>
        </level>
      </level>
      <level label="iii">
        <text>“Person eligible for relief” has the meaning stated in § 4–501 of the Family Law Article.</text>
      </level>
    </level>
    <level label="2">
      <text>Any competent individual may, at any time, make a written or electronic advance directive appointing an agent to make health care decisions for the individual under the circumstances stated in the advance directive.</text>
    </level>
    <level label="3">
      <level label="i">
        <text>A disqualified person may not serve as a health care agent unless the person:</text>
        <level label="1">
          <text>Would qualify as a surrogate decision maker under § 5–605(a) of this subtitle; or</text>
        </level>
        <level label="2">
          <text>Was appointed by the declarant before the date on which the declarant received, or contracted to receive, health care from the facility.</text>
        </level>
      </level>
      <level label="ii">
        <text>An individual may not serve as a health care agent if:</text>
        <level label="1">
          <text>The individual is the subject of an interim, temporary, or final protective order and the declarant is a person eligible for relief under the order; or</text>
        </level>
        <level label="2">
          <text>Except as provided in subparagraph (iii) of this paragraph, the individual is the spouse of the declarant and:</text>
        </level>
        <level label="A">
          <text>The individual and declarant have executed a separation agreement; or</text>
        </level>
        <level label="B">
          <text>The individual or declarant has filed an application for divorce.</text>
        </level>
      </level>
      <level label="iii">
        <text>An individual may serve as a health care agent for a declarant after the date of the execution of a separation agreement or the filing of an application for divorce if the declarant:</text>
        <level label="1">
          <text>Is able to make a decision about the individual’s appointment as the declarant’s health care agent; or</text>
        </level>
        <level label="2">
          <text>Has otherwise indicated an intent to have the individual serve as the declarant’s health care agent.</text>
        </level>
      </level>
    </level>
    <level label="4">
      <text>An agent appointed under this subtitle has decision making priority over any individuals otherwise authorized under this subtitle to make health care decisions for a declarant.</text>
    </level>
    <level label="5">
      <text>A person who obtains new information that would prohibit an individual from serving as a declarant’s health care agent under paragraph (3)(ii) of this subsection shall provide the information to any health care provider or health care facility providing services to the declarant.</text>
    </level>
  </level>
  <level label="c">
    <level label="1">
      <level label="i">
        <text>Except as provided in subparagraph (ii) of this paragraph or paragraph (3) of this subsection, a written or electronic advance directive shall be dated, signed by or at the express direction of the declarant, and subscribed by two witnesses in the physical presence or electronic presence of the declarant.</text>
      </level>
      <level label="ii">
        <text>A written or electronic advance directive signed and witnessed in conformance with the provisions of Executive Order 20.04.10.01, authorizing remote witnessing and electronic signing of certain documents, shall be deemed to have been signed and witnessed in conformity with this subsection if the advance directive was signed and witnessed during the time that the executive order was in effect.</text>
      </level>
    </level>
    <level label="2">
      <level label="i">
        <text>Except as provided in subparagraphs (ii) and (iii) of this paragraph, any competent individual may serve as a witness to an advance directive, including an employee of a health care facility, nurse practitioner, physician assistant, or physician caring for the declarant if acting in good faith.</text>
      </level>
      <level label="ii">
        <text>The health care agent of the declarant may not serve as a witness.</text>
      </level>
      <level label="iii">
        <text>At least one of the witnesses must be an individual who is not knowingly entitled to any portion of the estate of the declarant or knowingly entitled to any financial benefit by reason of the death of the declarant.</text>
      </level>
    </level>
    <level label="3">
      <text>The State–designated health information exchange may accept as valid an unwitnessed electronic advance directive in the form of a video record or file to state the declarant’s wishes regarding health care for the declarant or to appoint an agent if the video record or file:</text>
      <level label="i">
        <text>Is dated; and</text>
      </level>
      <level label="ii">
        <text>Is stored in an electronic file by an electronic advance directives service recognized by the Maryland Health Care Commission.</text>
      </level>
    </level>
  </level>
  <level label="d">
    <level label="1">
      <text>Any competent individual may make an oral advance directive to authorize the providing, withholding, or withdrawing of any life–sustaining procedure or to appoint an agent to make health care decisions for the individual.</text>
    </level>
    <level label="2">
      <text>An oral advance directive shall have the same effect as a written or electronic advance directive if made in the presence of the attending physician, physician assistant, or nurse practitioner and one witness and if the substance of the oral advance directive is documented as part of the individual’s medical record. The documentation shall be dated and signed by the attending physician, physician assistant, or nurse practitioner and the witness.</text>
    </level>
  </level>
  <level label="e">
    <level label="1">
      <text>Unless otherwise provided in the document, an advance directive shall become effective when the declarant’s attending physician and a second physician certify in writing that the patient is incapable of making an informed decision.</text>
    </level>
    <level label="2">
      <text>If a patient is unconscious, or unable to communicate by any means, the certification of a second physician is not required under paragraph (1) of this subsection.</text>
    </level>
  </level>
  <level label="f">
    <level label="1">
      <text>It shall be the responsibility of the declarant to notify the attending physician that an advance directive has been made. In the event the declarant becomes comatose, incompetent, or otherwise incapable of communication, any other person may notify the physician of the existence of an advance directive.</text>
    </level>
    <level label="2">
      <text>An attending physician who is notified of the existence of the advance directive shall promptly:</text>
      <level label="i">
        <text>If the advance directive is written or electronic, make the advance directive or a copy of the advance directive a part of the declarant’s medical records; or</text>
      </level>
      <level label="ii">
        <text>If the advance directive is oral, make the substance of the advance directive, including the date the advance directive was made and the name of the attending physician, a part of the declarant’s medical records.</text>
      </level>
    </level>
  </level>
  <level label="g">
    <text>It shall be the responsibility of the declarant to notify a health care agent that the agent has been named in an advance directive to act on the declarant’s behalf.</text>
  </level>
  <level label="h">
    <text>Unless otherwise provided in the patient’s advance directive, a patient’s agent shall act in accordance with the provisions of § 5–605(c) of this subtitle.</text>
  </level>
  <level label="i">
    <text>The absence of an advance directive creates no presumption as to the patient’s intent to consent to or refuse life–sustaining procedures.</text>
  </level>
</section>
