You have probably heard the term “Advance Medical Directive” before. You may even have heard it here, on The Tyra Law Firm blog. But, do you fully understand what's included in an Advance Medical Directive? Are you clear on why you need one now, regardless of your family structure, accumulated wealth, property ownership, employment status, or any other reason? If not, we would like to take a little time to walk through what is included in an Advance Medical Directive in the State of Maryland.

Advance Medical Directive

An Advance Medical Directive (sometimes called an Advance Health Care Directive) is a group of documents that work together to inform loved ones and health care professionals about your treatment preferences, if you are unable to do so. First, you may be thinking: under what circumstances would I need to communicate medical treatment preferences and be unable to do so? Unfortunately, this actually happens fairly often. Any number of medical conditions, stemming from illness or injury, can incapacitate a person either temporarily or permanently. Whether this means you are fully unconscious or mentally unable to provide consent, there needs to be someone who understands your wishes and is legally empowered to communicate them on your behalf. That's where your Advance Medical Directive comes in. An Advance Medical Directive can include:

• Health Care Instructions
• Appointment of Health Care Agent
• Mental Health Treatment Directive
• HIPAA Authorizations
• Disposition of Final Remains

What do all these mean? Let's dive in. Health Care Instructions (Living Will)Maryland law, under the Health Care Decisions Act, allows adults the right to decide for themselves whether they want to receive a particular medical treatment. An Advance Medical Directive gives you the opportunity to think through any possible medical treatments that you want or don't want to have. This part of the Advance Medical Directive is sometimes called the Living Will. A Living Will allows you to express preferences for medical treatments and procedures, as well as life-saving measures and end-of-life care. Using your Living Will, you can express whether you consent or refuse treatment such as

• Blood Transfusions
• Life Support
• Resuscitation Measures
• Feeding through Tubes
• Pain Relief Medication

You are permitted to include as much or as little information here as you wish. If there are certain medical interventions for which you have no preference, you can skip them! This decision-making process is about you and your wishes. You can take your time to decide if you have specific preferences at all. In fact, it is important to mention that these decisions can easily be amended, adapted, and expanded over time. If you do not have a specific preference now, feel free to skip certain decisions. Down the road, as you age, you may want to express different preferences.

Appointment of Health Care Agent

As your agent (sometimes called a “proxy”), this designated person must make medical decisions in accordance with any expressed wishes you may have made, in writing or orally. However, if your wishes are not known to the agent, he or she must act in good faith to serve your best interest. Before selecting a health care agent, make sure that you sit down and have a conversation with this person. First, ensure that they understand what you are asking them to do and confirm that they accept the responsibility. For help communicating what is included in health care agent responsibilities, check out the Maryland Attorney General's Making Medical Decisions for Someone Else: A Maryland Handbook. If they accept, then discuss your preferences openly with them. This will give you a chance to express your wishes to them, address any concerns they may have, and clarify the reasons behind your decisions. Not only will this ensure that your wishes are carried out if the need should arise, but it also greatly eases the burden on your chosen agent. When he or she fully understands your wishes and the reasons behind them, they will more easily be able to express your preferences and defend them to health care providers, as well as family and friends.

Mental Health Treatment Directive

Under your Advance Medical Directive umbrella, you can even include your preferences about mental health treatment. With a Mental Health Treatment Directive, you can consent to or refuse any specific treatments, medications, and/or interventions. If you have a current mental health condition, you can use this Directive to communicate common symptoms, as well as preferred medications or interventions that have worked in the past. If you find yourself in a mental health crisis down the road, this information will be incredibly valuable both to your loved ones and your health care providers. Whether you have an existing mental health condition or simply would like to cover your bases for the future, a Mental Health Treatment Directive can be very important. Using this document, you can express your preferences, consent, and refusal with regard to medications and other treatment. If you complete a Mental Health Treatment Directive and an Appointment of Health Care Agent, your designated agent will be empowered to make decisions on your behalf, but he or she can be guided by your express wishes articulated in your Directive.

HIPAA Authorizations

The final part of your Advance Medical Directive has to do with your privacy. Under the Health Insurance Portability and Accountability Act (HIPAA), your medical condition, status, and treatment is between you and your doctor. Others are not permitted to receive personal information from your health care providers without your consent. But, what if you are unable to communicate consent? What if your loved ones are worried about you, waiting to hear about your condition, and are unable to communicate with the doctor? That's where a HIPAA Authorization is essential. HIPAA Authorizations are relatively simple forms that allow you to designate individuals to whom medical providers can disclose medical information. Make sure to include any and all loved ones who you wish to receive important medical information, if you are unable to consent to the communication.

Disposition of Final Remains

This part of your Advance Medical Directive sounds a bit gloomy. In fact, it really doesn't have to be. Sure, this is where you will communicate whether you want your body donated, cremated, or buried. But it's also a place where you can express your unique personality to those you love. You can be as clinical or as creative as you like here. Some people even take the opportunity, while writing their Disposition of Final Remains, to record messages or write letters to loved ones. You can communicate funeral preferences and share information about burial plots. If you aren't sure yet what you want done with your remains, you can skip this part. But, make sure you come back to it after a conversation with loved ones.

Creating Your Advance Medical Directive

To create an Advance Medical Directive, a person over the age of 18 and who is determined to be capable of making informed decisions can express these wishes in writing. Written wishes should be signed, dated, and witnessed by two adults. Your health care agent cannot be one of the witnesses, and at least one of the witnesses should be a totally disinterested party (meaning, someone who will not receive anything of value after your death). It is important to note that, although your Directive is legally enforceable, it can be overridden by your healthcare provider, especially if you are involuntarily committed for psychiatric care.

So, What are You Waiting for?

You've heard me talk before about all of the excuses people use to avoid starting on their estate plan. Things like “I don't own a home yet,” or “I really don't have that much money,” or “I am still so young.” Of course, those reasons don't really hold up against the true importance of creating a comprehensive estate plan. However, I do get it. Estate planning can seem overwhelming and far off in the future. But, think about this: your Advance Medical Directive doesn't have anything to do with your family structure, the amount of money you have in the bank, or how old you are. Anyone can get injured or fall ill at any time, and you need to be prepared. Call The Tyra Law Firm to get started today, (301) 315-0811.