Lessons from Real Life: Why Everyone Needs an Advance Health Care Directive


End-of-life decisions are among the most difficult a family will ever face.  Most people do not like to think about life support, ventilators, and artificial food and hydration.  Young people, especially, believe that end-of-life decisions can wait until later.

The case of 33-year-old Marlise Munoz should be a wake-up call for everyone.  Marlise, a 33-year old paramedic, was found unconscious at home just before Thanksgiving.  Efforts to revive her failed, and just a few days later, she was pronounced brain dead at a Texas hospital.  Her family members, who are all in agreement about what Marlise would have wanted, said their goodbyes and instructed the hospital to remove her from life support.

But the hospital refused. 

Citing a state law that allows health care providers to override a woman’s end-of-life decisions if she is pregnant, hospital officials in Texas refused to terminate Marlise’s life support – because she was 14 weeks pregnant.  Marlise’s family spent the next two months in an agonizing fight with the hospital, finally asking a Texas court to determine the fate of Marlise and her unborn child.

While Marlise’s situation hinged upon a particular provision of Texas law, the case brings to light a significant issue: the importance of knowing your rights about your end-of-life decisions, and taking the necessary steps to make your wishes known.

In Maryland, this is accomplished by executing an Advance Health Care Directive.    An Advance Health Care Directive is a simple document that authorizes one or more individuals to make medical decisions on your behalf when you cannot.  Unlike several other states, including Texas and Illinois, which automatically invalidate a pregnant woman’s end-of-life decisions, Maryland law specifically allows a woman to write her wishes regarding pregnancy into her Advance Health Care Directive.  A Maryland Advance Health Care Directive gives voice to your wishes – and ensures that they will be carried out.  

The public tragedy of Marlise’s family is a real-life lesson that everyone should have an Advance Health Care Directive – or run the risk of forcing family members to fight for your rights. 

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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