HARRY HUGHES, Governor

3225

SECTION 1. BE. IT ENACTED BY THE GENERAL ASSEMBLY OF
MARYLAND, That the Laws of Maryland read as follows:

Article - Health - General

5-602.

(c) (1) The declaration shall be substantially in the
following form:

"DECLARATION

ON THIS ______ DAY OF ____________ (MONTH, YEAR), I,

________________ BEING OF SOUND MIND, WILLFULLY AND VOLUNTARILY

DIRECT THAT MY DYING SHALL NOT BE ARTIFICIALLY PROLONGED UNDER
THE CIRCUMSTANCES SET FORTH IN THIS DECLARATION:

If at any time I should have an incurable injury, disease,
or illness certified to be a terminal condition by two (2)
physicians who have personally examined me, one (1) of whom shall
be my attending physician, and the physicians have determined
that my death is imminent and will occur whether or not
life-sustaining procedures are utilized and where the application
of such procedures would serve only to artificially prolong the
dying process, I direct that such procedures be withheld or
withdrawn, and that I be permitted to die naturally with only the
administration of medication, the administration of food and
water, and the performance of any medical procedure that is
necessary to provide comfort care or alleviate pain. In the
absence of my ability to give directions regarding the use of
such life-sustaining procedures, it is my intention that this
declaration shall be honored by my family and physician(s) as the
final expression of my right to control my medical care and
treatment.

[Declaration made this _____ day of___________(month,

year). I, _______________________, being of sound mind,

willfully and voluntarily direct that my dying shall not be
artificially prolonged under the circumstances set forth in this
declaration:]

I am legally competent to make this declaration, and I
understand its full import.

Signed_____________________________

Address_____________________________

Under penalty of perjury, we state that this declaration was
signed by _____________________ in the presence of the