Ch. 372                                     1993 LAWS OF MARYLAND

I DIRECT THAT I BE PROVIDED WITH FOOD AND WATER AS LONG AS I AM ABLE
TO TAKE THEM BY MOUTH. MY WISHES CONCERNING THE USE OF A FEEDING TUBE
INSERTED INTO MY BODY TO SUPPLY ME WITH FOOD AND WATER ARE AS FOLLOWS:
(WRITE YOUR INITIALS NEXT TO ONLY ONE OF THESE STATEMENTS)

I WANT A FEEDING TUBE TO BE USED IF I AM NOT LONGER ABLE TO TAKE
FOOD AND WATER BY MOUTH.

____ I DO NOT WANT A FEEDING TUBE TO BE USED IF I AM NO LONGER ABLE

TO TAKE FOOD AND WATER BY MOUTH.

____ 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] LIVING WILL was signed
by ... in the presence of the undersigned who, at ... request, in ... presence, and in the
presence of each other, have hereunto signed our names as witnesses this ... day of ...
19.... Further, each of us, individually, states that: The declarant is known to me, and I
believe the declarant to be of sound mind. I did not sign the declarant's signature to this
[declaration] LIVING WILL. [Based upon information and belief, I am not related to the
declarant by blood or marriage, a creditor of the declarant, entitled to any portion of the
estate of the declarant under any existing testamentary instrument of the declarant,
entitled to any financial benefit by reason of the death of the declarant, financially or
otherwise responsible for the declarant's medical care, nor an employee of any such
person or institution.]

...............................................................—Address ...............................................................

Address

[(2)](B) The [declaration] LIVING WILL may include additional provisions
on this or other subjects that are not inconsistent with other provisions of this subtitle. If
any additional provisions are declared invalid, the invalidity does not affect the validity of
the [declaration] LIVING WILL or of other provisions which can be given effect without
the invalid provision, and to this end the provisions in the [declaration] LIVING WILL
are severable.

[5-604.] 20A-407. REQUIRED ACTIONS BY ATTENDING PHYSICIAN.

(a) Subject to the provisions of subsections (b) and (c) of this section and if the
declarant is unable to give directions regarding the use of life sustaining procedures, the
attending physician of a declarant in a terminal condition OR A PERSISTENT
VEGETATIVE STATE shall promptly:

(1) Take the actions necessary to provide for the certification required for
the declarant to become a qualified patient; and

(2) Upon certification, implement the [declaration] LIVING WILL.

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