Would you not want your spouse, adult children, or other close family members to make decisions regarding your health care if you could not do so yourself? Most of the time, you would be right. Making end-of-life choices is more nuanced than it may initially appear. Regarding your health care, you can only choose one to follow your preferences if they have been designated as your legal decision-maker. I'd like you to please read on for some essential details to remember when selecting end-of-life medical decisions.

Distinguishing Between a Surrogate and a Health Care Agent

A surrogate is a member of the family who is not a healthcare agent. The Health Care Decision Act of Maryland establishes restrictions on the authority of health care proxies in that state. The legislation defines surrogate decision-makers as the patient's spouse (if any), the patient's parents (if any), adult children, and siblings. If none of the above applies, an affidavit detailing the witness's relationship to the patient can be completed by another individual. The designated surrogate is then that individual.

If you have a health care power of attorney in place, the person you have named as your agent for medical decisions is called an agent for health care. Powers of attorney are often executed with other prior directives, such as a living will or "Five Wishes" letter—the person you appoint as your healthcare agent can be anyone you trust to do so for you. If you don't trust your spouse or kids to fulfill your desires, you can choose a close friend or cousin instead. To ensure that your final healthcare decisions are made by someone you trust and who is aware of your preferences, consider designating a healthcare agent.

A healthcare agent is more potent than a healthcare proxy. The option to alter the patient's "Code Status" (i.e., whether or not they require CPR) on the MOLST form is the most crucial of these (Maryland Orders for Life-Sustaining Treatment). All Maryland residents being moved between facilities must fill out a MOLST form (for example, from a hospital to a nursing home). If you do not want CPR or if you only want mechanical breathing or non-invasive ventilation (a CPAP or BPAP mask) but no CPR, a MOLST form is a good idea to have on hand. Businesses and the EMS (Emergency Medical Services) can carry out cardiopulmonary resuscitation with this paperwork.

Other Factors to Consider:

Having a health care power of attorney and living will on file helps ensure that you do not receive CPR if two doctors deem it hopeless. Still, they can also be used for other purposes. The concept of futility is highly relative. Please specify the circumstances under which you do not want to be resuscitated rather than letting futility be the deciding factor.

So that you know, the people you've selected to make decisions must be aware of and comfortable with this duty before you begin drafting the documents. It's a chance to reflect on the future and share your hopes and aspirations. Your loved ones will feel more at ease and secure making choices on your behalf if they know they are doing it under a directive. It's your last act of kindness to the people you care about, and it could save them a great deal of stress and heartache during a time that will be challenging enough without your added burden. So that you know – the time to act is now if you're serious about fixing this.

Here’s some guidance:

1. Study the materials (Maryland Attorney General website for MOLST and advance directive; some people prefer the “Five Wishes” form available from AgingwithDignity.org) and think about what you would want to be done as you near the end of your life, and who you would like to make decisions for you. Complete the Health Care Decision Maker, even if you are unsure about your wishes.
2. Talk to the person you want to be your decision-maker; make sure they understand and agree to carry out your wishes.
3. Talk to your doctor and make sure they have a record of your advance directive or power of attorney, and talk to your doctor about your goals (Medicare will pay for this visit).

You may also want to consult with an attorney (usually the same person helping to prepare your will). However, there is no requirement for a lawyer—or even a notary—to complete a health care power of attorney. You need two witnesses. The witnesses cannot be the people you name as your agents or anyone who may inherit or otherwise profit from your death (details are spelled out in the form).

Resources:
marylandmolst.org (Maryland MOLST forms and directions)
Agingwithdignity.org (Five Wishes)
theconversationproject.org/starter-kits/