"Advance Directive" means:
A witnessed written document, voluntarily executed by the declarant in accordance with the requirements of this Policy; or
A witnessed oral statement made by the declarant to the attending physician or nurse practitioner documented in the medical record in accordance with the provisions of this Policy.
"Agent" means an adult appointed by the declarant under an advance directive in accordance with the provisions of this Policy to make health care decisions for the declarant.
"Attending Physician" means the physician who has primary responsibility for the treatment and care of the Resident.
"Best Interest" means that the benefits to the individual resulting from a treatment outweigh the burdens to the individual resulting from that treatment, taking into account:
The effect of the treatment on the physical, emotional and cognitive functions of the individual;
The degree of physical pain or discomfort caused to the individual by the treatment or the withholding or withdrawal of the treatment;
The degree to which the individual's medical condition, the treatment, or the withholding or withdrawal of treatment result in a severe and continuing impairment of the dignity of the individual by subjecting the individual to a condition of extreme humiliation and dependency;
The effect of the treatment on the life expectancy of the individual;
The prognosis of the individual for recovery, with and without the treatment;
The risks, side effects and benefits of the treatment or the withholding or withdrawal of the treatment; and
The religious beliefs and basic values of the individual receiving treatment, to the extent these may assist the decision maker in determining best interest.
"Competent Individual" means a person who has not been determined to be incapable of making an informed decision and who is at least eighteen (18) years of age or who under Health-General Article, §20-102(A) has the same capacity as an adult to consent to medical treatment.
"Declarant" means a competent individual who makes an advance directive while capable of making and communicating an informed decision.
"Disqualified Person" means:
An owner, operator, or employee of a health care facility from which the declarant is receiving health care; or
A spouse, parent, child, or sibling of an owner, operator, or employee of a health care facility from which the declarant is receiving health care.
"Domestic Partnership" means a relationship between two individuals who are at least eighteen (18) years old who:
- Are not related to each other by blood or marriage within four degrees of consanguinity under civil law rule;
- Are not married or in a civil union or domestic partnership with another individual; and
- Agree to be in a relationship of mutual interdependence in which each individual contributes to the maintenance and support of the other individual and the relationship, even if both individuals are not required to contribute equally to the relationship.
"End-Stage Condition" means an advanced, progressive, irreversible condition caused by injury, disease, or illness:
That has caused severe and permanent deterioration indicated by incompetency and complete physical dependency; and
For which, to a reasonable degree of medical certainty, treatment of the irreversible condition would be medically ineffective.
"Health Care Practitioner" means:
An individual licensed or certified under the Health-Occupations Article to provide health care; or
The administrator of a facility or a person designated by the administrator in accordance with facility policy.
"Health Care Provider" means a health care practitioner or a facility that provides health care to individuals. "Health care provider" includes agents or employees of a health care practitioner, or a facility that provides health care to individuals.
"Incapable of Making an Informed Decision" means the inability of an adult Resident to make an informed decision about the provision, withholding or withdrawal of a specific medical treatment or course of treatment because the Resident is unable to understand the nature, extent, or probable consequences of the proposed treatment or course of treatment, is unable to make a rational evaluation of the burdens, risks and benefits of the treatment or course of treatment, or is unable to communicate a decision. For purposes of this Policy, a competent individual who is able to communicate by means other than speech may not be considered incapable of making an informed decision.
"Instructions on Current Life-Sustaining Treatment Options Form" means the form adopted in regulations by the Maryland Attorney General's Office to document preferences about currently relevant life-sustaining treatment issues. A sample of the form is provided in Attachment J.
"Life-Sustaining Procedure" means any medical procedure, treatment, or intervention that:
Utilizes mechanical or other artificial means to sustain, restore, or supplant a spontaneous vital function; and
Is of such a nature as to afford a Resident no reasonable expectation of recovery from a terminal condition, persistent vegetative state, or end-stage condition. Life-sustaining procedure includes artificially administered hydration and nutrition, and cardiopulmonary resuscitation.
"Medically Ineffective Treatment" means that, to a reasonable degree of medical certainty, a medical procedure will not:
Prevent or reduce the deterioration of the health of an individual; or
Prevent the impending death of an individual.
"Nurse Practitioner" means an individual licensed to practice nursing in the state and who is certified as a nurse practitioner by the State Board of Nursing under Title 8 of the Health Occupations Article of the Maryland Code.
"Patient Care Advisory Committee" means the multidisciplinary committee established under Section 19-371 of the Health-General Article of the Maryland Code to, among other things, provide advice to the medical staff and patients regarding medical decision-making.
"Persistent Vegetative State" a condition caused by injury, disease, or illness:
In which a Resident has suffered a loss of consciousness, exhibiting no behavioral evidence of self-awareness or awareness of surroundings in a learned manner other than reflex activity of muscles and nerves for low level conditioned response; and
From which, after the passage of a medically appropriate period of time, it can be determined, to a reasonable degree of medical certainty that there can be no recovery.
"Physician" means a person licensed to practice medicine in the state or in the jurisdiction where the treatment is to be rendered or withheld.
"Resident" means an adult who has been admitted to a long-term care facility and includes, as the context may indicate, a Resident who is receiving care in a hospital, ambulatory surgical center, or similar facility.
"Terminal Condition" means an incurable condition caused by injury, disease, or illness which, to a reasonable degree of medical certainty, makes death imminent and from which, despite the application of life-sustaining procedures, there can be no recovery.
After reasonable inquiry, a health care provider is unaware of the existence of a surrogate decision maker;
After reasonable inquiry, a health care provider cannot ascertain the whereabouts of a surrogate decision maker;
A surrogate decision maker has not responded in a timely manner, taking into account the health care needs of the individual to a written or oral message from a health care provider;
A surrogate decision maker is incapacitated; or
A surrogate decision maker is unwilling to make decisions concerning health care for the individual.
Life-sustaining procedure includes artificially administered hydration and nutrition, and cardiopulmonary resuscitation.