Ch. 372                                     1993 LAWS OF MARYLAND

(SIGNATURE OF TWO WITNESSES)

PART B

ADVANCE MEDICAL DIRECTIVE
HEALTH CARE INSTRUCTIONS

(OPTIONAL FORM)

(CROSS THROUGH IF YOU DO NOT WANT TO COMPLETE THIS PORTION OF THE
FORM. IF YOU DO WANT TO COMPLETE THIS PORTION OF THE FORM, INITIAL THOSE
STATEMENTS YOU WANT TO BE INCLUDED IN THE DOCUMENT AND CROSS
THROUGH THOSE STATEMENTS THAT DO NOT APPLY.)

IF I AM INCAPABLE OF MAKING AN INFORMED DECISION REGARDING MY HEALTH
CARE, I DIRECT MY HEALTH CARE PROVIDERS TO FOLLOW MY INSTRUCTIONS AS
SET FORTH BELOW. (INITIAL ALL THOSE THAT APPLY.)

(1)    IF MY DEATH FROM A TERMINAL CONDITION IS IMMINENT AND EVEN IF
LIFE-SUSTAINING PROCEDURES ARE USED THERE IS NO REASONABLE
EXPECTATION OF MY RECOVERY -

______ I DIRECT THAT MY LIFE NOT BE EXTENDED BY LIFE-SUSTAINING

PROCEDURES, INCLUDING THE ADMINISTRATION OF NUTRITION AND HYDRATION
ARTIFICIALLY.

I DIRECT THAT MY LIFE NOT BE EXTENDED BY LIFE-SUSTAINING
PROCEDURES, EXCEPT THAT IF I AM UNABLE TO TAKE FOOD BY MOUTH, I WISH TO
RECEIVE NUTRITION AND HYDRATION ARTIFICIALLY.

(2)    IF I AM IN A PERSISTENT VEGETATIVE STATE, THAT IS, IF I AM NOT CONSCIOUS
AND AM NOT AWARE OF MY ENVIRONMENT OR ABLE TO INTERACT WITH OTHERS,
AND THERE IS NO REASONABLE EXPECTATION OF MY RECOVERY -

I DIRECT THAT MY LIFE NOT BE EXTENDED BY LIFE-SUSTAINING
PROCEDURES, INCLUDING THE ADMINISTRATION OF NUTRITION AND HYDRATION
ARTIFICIALLY.

I DIRECT THAT MY LIFE NOT BE EXTENDED BY LIFE-SUSTAINING
PROCEDURES, EXCEPT THAT IF I AM UNABLE TO TAKE FOOD BY MOUTH, I WISH TO
RECEIVE NUTRITION AND HYDRATION ARTIFICIALLY.

- 2048 -