If you’re handling a loved one’s estate in Maryland and they had a healthcare directive, you’ll need to follow specific legal steps to make sure their medical wishes are respected and that the estate process moves forward without delays or disputes. A healthcare directive isn’t part of the probate process itself, but it directly affects how medical decisions are made during incapacity or at end-of-life, which can influence estate settlement timelines, asset distribution, and even who has authority to act. Getting this wrong like assuming a family member automatically has decision-making power, or filing the wrong document with the court can stall things or lead to conflict.

What counts as a “healthcare directive” in Maryland?

In Maryland, a healthcare directive usually means two separate but related documents: an advance directive (which includes a living will and healthcare power of attorney) and sometimes a mental health advance directive. The advance directive lets someone name a healthcare agent and state preferences for life-sustaining treatment. It’s not the same as a last will or trust and it doesn’t control property or money. That’s why people often confuse it with other estate planning tools. You can read more about what each document must include to be valid in Maryland on our page about Maryland healthcare directive requirements for estate planning.

When do these legal steps actually come into play?

These steps matter most when the person is no longer able to speak for themselves due to dementia, stroke, coma, or another serious condition and medical decisions need to be made. For example, if a hospital asks whether to continue ventilator support, and the patient signed a living will refusing life-prolonging measures, the directive guides that choice. It also matters during estate settlement if there’s uncertainty about who should authorize medical records, consent to autopsy, or handle funeral arrangements. In those cases, the healthcare agent named in the directive not the executor of the will has authority over those decisions.

How to file or use a healthcare directive during estate administration

Unlike a will, Maryland law does not require you to file a healthcare directive with any government office or court. But to make it effective, it must be properly signed and witnessed or notarized, depending on the type. If the person is hospitalized, give a copy to the attending physician and the hospital’s medical records department. If you’re acting as the healthcare agent, bring the original or a certified copy when speaking with providers. During estate settlement, keep the directive with other key documents like the death certificate and letters of administration especially if questions arise about care decisions made before death. You’ll find examples of where to store and reference it alongside other estate settlement documents for medical decisions.

Common mistakes people make

  • Assuming a spouse or adult child can decide without being named: Maryland doesn’t recognize “next of kin” decision-making by default. Only the person named in a valid healthcare power of attorney has legal authority.
  • Mixing up the healthcare agent and the executor: These roles serve different purposes. The executor handles assets after death; the healthcare agent makes medical choices while the person is alive but incapacitated.
  • Not updating the directive after major life changes: Divorce, estrangement, or a change in values may mean your original agent or instructions no longer reflect your wishes.
  • Storing the document where no one can find it: A directive locked in a safe or saved only on a personal phone won’t help during a crisis.

Can you include a healthcare directive in a Maryland will?

No you shouldn’t. A will only takes effect after death. Healthcare directives are for decisions made before death, while someone is still alive but unable to communicate. Trying to add healthcare instructions to a will creates confusion and may render those wishes unenforceable. Instead, keep them as separate, clearly labeled documents. If you want both documents referenced together in your overall plan, you can mention the existence of your advance directive in your will but don’t copy its contents there. See how to coordinate both in our guide on how to include healthcare directives in a Maryland will.

What to do next

If you’re preparing your own healthcare directive: sign it in front of two witnesses (no notary required for the basic form), give copies to your agent, primary doctor, and a trusted family member, and store the original somewhere accessible not just in your safe deposit box. If you’re helping settle an estate and a directive exists: confirm the named agent is still willing and able to act, check whether any medical decisions were made under it (and whether those align with the estate’s timeline), and keep documentation handy for the probate court if questions come up. For step-by-step instructions tailored to Maryland law, review the official Maryland Attorney General’s guidance on advance directives.

Quick checklist:

  1. Confirm the directive was signed and witnessed correctly under Maryland law
  2. Identify who the current healthcare agent is and verify they’re still available and willing
  3. Provide a copy to the treating physician or facility, if the person is receiving care
  4. Keep the original with your estate planning documents not inside your will
  5. Review your directive every 3–5 years, or after major life events like divorce or diagnosis