Health Care Decision Making


If you become incapable of making your own medical decisions, it is critical to have planning in place so that medical providers and family members know and can implement your wishes.   This is especially important if you have a serious illness or a condition with potentially life-threatening complications.

In Maryland, there are two primary components to such planning.  The first is an Advance Health Care Directive.  Once completed by you, this document appoints one or more trusted individuals to act as your health care agent.

Your health care agent can act on your behalf when you cannot.  He or she can access your medical information, talk with your doctors and health care providers, and make medical decisions for you, based on your wishes as you have made them known. 

The second part of your health care decision planning is the Maryland Medical Orders for Life-Sustaining Treatment (MOLST).  The MOLST is a medical order designed to make your wishes regarding end-of-life care and life-sustaining measures known to health care professionals.  The MOLST covers a number of very specific situations, including cardiopulmonary resuscitation (CPR), artificial ventilation, blood transfusion, hospital transfers, medical workups, antibiotics, artificially administered fluids and nutrition, and dialysis.

Since the MOLST is a medical order, you do not sign it.  Only a physician or nurse practitioner may sign it after discussions with you, if you are competent to make decisions, or if you are incapacitated, after discussions with those authorized to act for you or based upon information contained in your Advance Health Care Directive.

You will need a MOLST if you are admitted to certain health care facilities, including assisted living programs, home health agencies, hospices, kidney dialysis centers, and nursing homes.   Hospitals must complete a MOLST for you if you are being discharged to another hospital or to one of these types of facilities.  A completed MOLST will travel with your medical records and can freely pass from one facility to another.

Together, a MOLST and an Advance Health Care Directive can help make sure your wishes regarding your health care are carried out.

DISCLAIMER: Because of the generality of this update, the information provided herein may not be applicable in all situations and should not be acted upon without specific legal advice based on particular situations.

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