Maine Advance Health Care Directive (Living Will)

The Maine advance health care directive(living will) is an “Advance Directive” document meaning, an individual, while of sound mind, may plan in advance, how they would like to direct their health care providers and health care representative(s) -(if any) with issues pertaining to their end of life choices. This document will allow the Principal to select someone they trust to assist their health care providers with decision-making processes if/when they are no longer able to competently make their own decisions. As long as the Principal is of sound mind, they may also revoke this document at their own discretion. As per the second portion of the “Note” portion of the document “Before filling out this form, we suggest that you talk with your lawyer, family members, physicians, and others close to you about your wishes. If you make changes or complete a new form, be sure to let everyone know.”

Laws – Title 18-A, §§5-801 to 5-817

How to Write

Step 1 – The Principal must download the document and begin by carefully reviewing the “Note” at the top of the page

  • Submit (print) the Principal’s full name
  • Complete address
  • Date of birth in mm/dd/yyyy format
  • In the lines provided create a list of the persons who will have copies of the Principal’s signed Advance Directive

Step 2 – Read through the instruction page to ensure there is a clear understanding of the requirements

Step 3 – Completing the Advance Directive – Complete all of the required fields as follows:

  • Principal’s name
  • Agent’s name
  • Agent’s relationship to the Principal
  • Agent’s address
  • Agent’s home telephone
  • Agent’s work telephone

Alternate Agents – In the event the first agent is unable or unwilling or is not available the Principal may name up to two (2) alternate agents by providing the following information, respectively:

  • Agent’s name
  • Agent’s relationship to the Principal
  • Agent’s address
  • Agent’s home telephone
  • Agent’s work telephone

Should the Principal decide the would like to stop the current agents from service they must simply have their physician complete the information required and as provided on the document. The Principal must sign this section with the physician present.

  • Enter the date that this section was completed in mm/dd/yyyy format
  • Any changes should prompt copies to be provided to all who have copies of the original

Step 4 – Agent’s Power –

  • Check A or B
  • Read the information regarding nomination of a guardian – If the courts decide the Principal will require a guardian, the Principal may nominate their agent by checking the indication box.
  • Should the Principal require another person, the Principal may nominate someone else by provision of the following information:
  • Appointee’s name
  • Title or relationship to the Principal
  • Address (complete)
  • Home phone
  • Work phone

Step 5 – Special Instructions – The Principal must review the instructions whether or not they selected an agent:

  • With regard to choices for life-sustaining treatment, review and check one of the boxes
  • Be certain to read the information with regard to a late-stage Alzheimer’s disease diagnosis
  • Check the applicable box regarding a choice for tube feeding
  • Check the box pertaining to pain relief and enter any wishes the Principal may have with regard to any special wishes in the pain relief section provided

Other Directions: If the Principal would like to expand on any other wishes regarding treatment they may place this information into this section

Step 6 – (Optional The Principal may name their Primary Physician here by entering the following:

  • Name of primary physician
  • Address
  • Telephone

If the Principal would like their Agent to speak with their physician enter the following:

  • Name of physician
  • Address
  • Phone
  • AND
  • Name of nurse practitioner or physician assistant
  • Address
  • Phone

Step 7 – Donation of Body – Organs or Tissues at Death (Optiona)

  • The Principal must read through this section and check any applicable boxes (if any at all)
  • Provide any special instructions should they be required among your selections

Step 8 – Funeral and Burial Arrangements – (Optional)

  • The Principal may complete this section, only if they wish to provide special instructions with regard to their funeral arrangements in this document
  • Should it be the intention of the Principal to pass away from their home, they should talk to their physician and the funeral director about their plans

Step 9 – Signatures – The Principal’s Agent may not sign as witness to this document

  • Read the instructions at the top of the page and follow them specifically
  • Signatures must be signed with all signatories present with the Principal and provide the required information as follows:

Principal –

  • Submit the Principal’s signature
  • Print name
  • Address
  • Date the Principal’s signature in mm/dd/yyyy format

Witnesses -Signing respectively-

  • Witnesses Signatures
  • Printed names
  • Complete addresses
  • Date of signatures in mm/dd/yyyy format

Notarization – Once the notary has witnessed all signatures, the notary shall acknowledge the document

  • The Principal must review the remainder of this section

Step 10 – Instructions to EMS – The Principal must read all of the information in this section

Do Not Resuscitate Directive – The Principal must carefully review this document

  • Check the boxes that would apply to the choices of the Principal
  • Enter the Principal’s name in the first line of the DNR Document
  • Provide an expiration date
  • The Principal must provide their signature
  • Date the signature in mm/dd/yyyy format
  • The remainder of this document must be reviewed and signed by medical staff