guardian, however, may have more authority than a guardian to make serious medical decisions. Some guardians must get court approval before they can consent to the provision, withdrawal, or withholding of treatment that involves a substantial risk of life to the patient. Md. Code, Health-General Art., § 5-605 Medical Order for Life-Sustaining Treatment (MOLST). A MOLST is a written medical order that outlines a patient’s preferences regarding life-sustaining treatment including CPR, blood transfusions, artificial ventilation, and medical tests. A MOLST can be created by the patient, their health care agent, a surrogate decision-maker, or a guardian of the person. It must be signed by a physician, nurse practitioner, or physician’s assistant. It should also be included in the patient’s medical records and be kept with the patient during admission or discharge to a health care facility. For more information and resources for patients, families, and providers visit marylandmolst.org. Md. Code, Health-General Art., § 5-608.1 Withholding or withdrawal of medically ineffective treatment. Physicians and physician assistants are not required to provide treatment that they believe is medically ineffective. Medically ineffective treatment is defined as treatment that, to a reasonable degree of certainty, will neither prevent nor reduce the deterioration of an individual’s health or prevent their impending death. If the patient’s physician, and a second physician, certify in writing that a treatment is considered medically ineffective under generally accepted medical practices, the patient’s attending physician can withhold or withdraw the treatment. If they decide to do so, the patient, their agent, or their surrogate must be notified. If the patient has a guardian, the guardian may need to get court approval before consenting to the withholding or withdrawal of medically ineffective treatment. The amount of time it takes for a guardian to get such approval varies. Md. Code, Health-General Art., § 5-611; Md. Code, Estates & Trusts Art., §13-705 Home and Community-Based Services (HCBS) and informal options. Home and Community-Based Services and informal options allow a patient to be safely discharged to their community. They include:
Surrogate Priorities: 1. A court-appointed guardian 2. A spouse or domestic partner (even if the couple has been separated for years) 3. Adult children 4.Parents 5. Adult siblings 6. A close friend or relative who is competent and who signs an affidavit (a statement under oath) stating: • t hat they are a close relative or close friend, and • specific facts and circumstances that show that they have known the patient for enough time to know their beliefs, wishes, activities, and health WATCH VIDEO SCAN ME Multiple people can share decision-making responsibility. For example, a patient may have multiple adult children who need to work together to make decisions. If they cannot reach an agreement, your facility’s Patient Care Advisory Committee can review the situation and make a recommendation. A class of individuals with shared surrogate decision-making authority (e.g., a group of siblings), can execute an agreement that appoints one or more class members to act as the patient’s surrogate. A surrogate must make decisions based on what the patient would want if they could decide (substituted judgment). If the patient’s wishes are unknown or unclear, then the surrogate must act in the patient's best interests and consider a variety of factors when making decisions. These factors include the patient’s relevant religious and moral considerations and past behavior and conduct towards the treatment at issue. Surrogates cannot authorize a patient’s sterilization or treatment for a mental disorder. A surrogate who is not a court-appointed
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