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Advance Directive in Maryland: The State Form, the Living Will and the Two-Witness Rule
Maryland's advance directive can name a health care agent, state living will preferences, or both. It needs two witnesses and no notary. Here is how it works under the Health Care Decisions Act.
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What to know
- A Maryland advance directive must be dated, signed by your parent and signed by two witnesses; Maryland law doesn't require a notary (Health - General § 5-602).
- The health care agent can't be a witness, and at least one witness must not knowingly inherit or otherwise benefit financially from your parent's death.
- The state form, printed in § 5-603 and offered free in an Attorney General version, combines a health care agent (Part I) and a living will (Part II).
- Without an agent, Maryland law sets an order of surrogates: a guardian, then the spouse or domestic partner, then adult children, parents, adult siblings, then a qualifying friend or relative (§ 5-605).
- Retirement Checklist puts these documents in order alongside everything else your family needs to settle.
A Maryland advance directive is a document, signed before two witnesses and no notary, in which your parent names a health care agent, states treatment wishes as a living will, or both. The law is the Health Care Decisions Act, Health - General §§ 5-601 to 5-618. Under § 5-602, it "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." The state's form adds: "Maryland law does not require this document to be notarized."
What is an advance directive in Maryland?
It's a witnessed document that appoints a health care agent, states wishes about treatment, or does both, because Maryland uses one name for both jobs. Any competent adult can make an advance directive appointing "an agent to make health care decisions," and can make one stating wishes about "the provision of health care to that individual, or the withholding or withdrawal of health care." One document can do both. The Attorney General's office notes that some people call the agent appointment "a durable power of attorney for health care, but it is legally binding regardless of the name."
The agent's authority depends on what the directive says. An agent "has decision making priority over any individuals otherwise authorized under this subtitle to make health care decisions" for your parent. It's separate from a financial power of attorney, which can't make health care decisions; see our Maryland power of attorney guide.
What is a living will in Maryland?
A living will is the part of an advance directive that states treatment preferences instead of naming an agent. In the state form it's "PART II: TREATMENT PREFERENCES" and covers three situations: "terminal condition, persistent vegetative state, and end–stage condition." For each, your parent can initial one choice, from comfort care only to trying to extend life as long as possible, including whether they want tube feeding.
| Part of the state form | What it does |
|---|---|
| Part I, Selection of health care agent | Names an agent and backups, and sets when the agent's power begins |
| Part II, Treatment preferences (living will) | States wishes for a terminal condition, persistent vegetative state or end-stage condition, plus pain relief |
| Part III, Signature and witnesses | Your parent's signature and two witnesses |
"You can fill out Parts I and II of this form, or only Part I, or only Part II." In Part II, your parent also chooses whether their preferences are a flexible guide or must be followed "exactly as written." For the general picture, see power of attorney vs. advance directive.
Where do you get the Maryland advance directive form?
The statute prints the form in § 5-603, titled "Maryland Advance Directive: Planning for Future Health Care Decisions." It says: "Using this advance directive form to do health care planning is completely optional. Other forms are also valid in Maryland." It includes an optional After My Death form for organ donation and funeral wishes.
The Maryland Department of Health's advance directive program links a free PDF of the Attorney General's version, "prepared from the May 2024 form and booklet." Its instructions say to initial your choices, "Do not use checkmarks or X marks," and "Do not return completed forms to the Office of the Attorney General." Instead, give copies to the doctor, the agent and backups, any hospital or nursing home, and family.
How do you sign a Maryland advance directive?
Your parent dates and signs it, or someone signs at their express direction, and two witnesses sign in your parent's physical or electronic presence. Under § 5-602(c), "any competent individual may serve as a witness," including a health care facility employee or a physician caring for your parent, acting in good faith. Two limits apply:
- "The health care agent of the declarant may not serve as a witness."
- At least one witness must be someone "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."
No notary is needed. Maryland also recognizes an oral advance directive made to the attending physician, physician assistant or nurse practitioner with one witness and documented in the medical record.
Who can't be the health care agent?
Under § 5-602(b), an owner, operator or employee of a health care facility where your parent is receiving care, or that person's spouse, parent, child or sibling, can't serve as agent, unless they'd qualify as a surrogate under § 5-605 or were appointed before your parent received or contracted for care there.
Two more exclusions: a person subject to a protective order protecting your parent, and a spouse after the couple has signed a separation agreement or either has filed for divorce. A spouse can still serve if your parent can decide about the appointment or "Has otherwise indicated an intent to have the individual serve as the declarant's health care agent."
When does the agent start making decisions?
"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" (§ 5-602(e)). A second physician isn't needed if your parent is unconscious or can't communicate by any means.
The state form lets your parent choose. One option makes the agent's power effective "Immediately after I sign this document, subject to my right to make any decision about my health care if I want and am able to." The other waits until your parent can't make informed decisions.
A 2026 law changed who certifies. Since October 1, 2026, the second certifier under § 5-606 can be a second physician, a nurse practitioner or a physician assistant (2026 Md. Laws ch. 222). When a decision rests on a living will with no agent, or on a surrogate, life-sustaining procedures can be withheld or withdrawn only after a terminal condition, end-stage condition or persistent vegetative state is certified.
What happens if your parent has no advance directive?
A surrogate decides, in an order set by § 5-605. If your parent is certified incapable of making an informed decision and has no available agent, these surrogates decide, in order:
- a guardian, if one has been appointed;
- the spouse or domestic partner;
- an adult child;
- a parent;
- an adult brother or sister;
- a friend or other relative who gives the attending physician an affidavit showing regular contact with your parent.
"Individuals in a particular class may be consulted to make a decision only if all individuals in the next higher class are unavailable." If surrogates in the same class, such as adult children, disagree and your parent is in a hospital or similar institution, the case goes to its patient care advisory committee; elsewhere, life-sustaining procedures can't be withheld or withdrawn without agreement among everyone in the same class. A surrogate can't authorize sterilization or treatment for a mental disorder. When a broader need arises, see our Maryland guardianship guide.
How do you revoke a Maryland advance directive?
Under § 5-604, your parent can revoke it "at any time" by "a signed and dated written or electronic document, by physical cancellation or destruction, by an oral statement to a health care practitioner or by the execution of a subsequent directive." Your parent is responsible, as far as reasonably possible, for telling everyone who has a copy.
One exception: your parent can choose, in the directive, to give up the right to revoke it during a period when they've been certified incapable of making an informed decision. The Attorney General's form notes that a directive "does not expire, and no one except you can change it while you have decision making capacity."
What about MOLST?
"The “Medical Orders for Life–Sustaining Treatment” form is not an advance directive." It's a medical order signed by a doctor, nurse practitioner or physician assistant, and according to the Maryland Institute for Emergency Medical Services Systems, "Maryland MOLST is a portable and enduring medical order form covering options for cardiopulmonary resuscitation and other life-sustaining treatments." Hospitals, nursing homes, assisted living programs, hospices and some other facilities must accept or complete one, and a copy goes to your parent or their decision-maker within 48 hours.
Frequently asked questions
Does an advance directive need to be notarized in Maryland?
No. Under Health - General § 5-602, a Maryland advance directive must be dated, signed by your parent and signed by two witnesses. The state form says Maryland law doesn't require it to be notarized, and the Attorney General's version answers the same question with a plain no.
Who can witness an advance directive in Maryland?
Any competent adult, including a health care facility employee or your parent's doctor acting in good faith, except the health care agent. At least one of the two witnesses must not knowingly inherit from your parent or otherwise gain financially from their death, so if one witness is an heir, the other must not be.
Where can I get a Maryland living will form?
The living will is Part II of the state's advance directive form in Health - General § 5-603. The Maryland Department of Health's advance directive program links a free PDF of the Attorney General's version. The form is optional; other forms are valid if they're signed and witnessed as Maryland law requires.
Who makes medical decisions in Maryland if there's no advance directive?
A surrogate under § 5-605: a guardian if appointed, then the spouse or domestic partner, an adult child, a parent, an adult sibling, then a friend or other relative who signs an affidavit. A lower class can be consulted only if everyone in the higher class is unavailable.
Is an advance directive from another state valid in Maryland?
Yes, if its signing complied with Maryland law or with the law of the state where it was signed. Under Health - General § 5-617, such a directive is deemed validly executed, and it's given effect to the extent Maryland law permits.
Can my parent change their mind after signing?
Yes. Your parent can revoke an advance directive at any time by a signed and dated writing, by destroying it, by telling a health care practitioner, or by signing a new one, unless they chose in the directive to waive revocation while certified incapable. The state form says to make a new advance directive if wishes change.
Getting started
An advance directive only helps if it's signed while your parent can sign it, with two witnesses who aren't the agent, and if copies reach the doctor and the agent. The plan this site builds asks four questions, including which state your parents live in, and puts the steps that matter most for your family in order. It's free and takes about 90 seconds.
Related guides
Sources
- Md. Code, Health - General § 5-602, Health Care Decisions Act: making and signing an advance directive and who can't be the agent; the act runs from §§ 5-601 to 5-618, including the form (§ 5-603), revocation (§ 5-604), surrogates (§ 5-605), MOLST (§ 5-608.1) and out-of-state documents (§ 5-617).
- Md. Code, Health - General § 5-603: the statutory advance directive form.
- 2026 Md. Laws ch. 222 (SB 326): physician assistants in the incapacity certification under § 5-606, effective October 1, 2026.
- Maryland Department of Health, Advance directive program resources: the free form from the Office of the Attorney General.
- Maryland Institute for Emergency Medical Services Systems, MOLST: what the MOLST form is.
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