Hospital visitation rights and health-care decision-making authority in Maryland Suppose there is person A who lives in Maryland. Person A has parents B and C. Person A has sibling D. Person A has spouse E. Now, Suppose person A becomes medically incapacitated. Three Questions: Can E block B, C and D from visiting A in the hospital? What legal authorization form(s) can person A fill out and provide to B, C and D to prevent that from happening if this is a serious concern? What legal authorization form(s) can person A fill out and provide to B and C so that they get precedence in medical decision-making authority over E?
This is a valid question that comes up from time to time. The answer can be a bit fuzzy and the law on questions 1 and 2 is often not well spelled out. This answer refers only to U.S. legal history without much customization for Maryland in particular, so I may omit references to some relevant Maryland specific statutes or cases of which I am not aware. Often there is no statutory guidance or there is only inconclusive or vague statutory guidance. There is often also little appellate case law precedent to provide guidance. The issue comes up far more often than it is litigated, in part, because these issues tend to become moot before they can be resolved by a precedent creating appellate court, and because statutes addressing the issue tend to be recent and not yet litigated, or non-existent. These issues are often highly time sensitive and don't have an economic prize to spend money litigating over are often not litigate to the maximum extent. Court rulings when cases are presented to them often depend a lot on the procedural context of the way the issue comes up, how the issue is framed by the litigants, and upon the court's gut feelings and upon unwritten social norms. For example, one recent case involving the ability of a priest to visit a man who was sick with COVID-19 in a Maryland hospital notwithstanding hospital visitation policies was resolved in the context of a complaint to the Maryland Office of Civil Rights and would not be generally applicable to an intrafamily dispute as opposed to an allegation of religion based discrimination. The hospital's opinion is often given outsized weight, since it is a &quot;neutral&quot; party in a family dispute, has a vested interesting in having litigation resolved that is more economic than that of the family members, and is likely to have counsel that is most familiar with the issues presented. this is true even though often, a hospital has a religious affiliation or is for some other reason specific to the facts of a case is not truly a &quot;neutral&quot; party in a visitation dispute and takes a position for a non-medical reason. As a young lawyer at a law firm that represented a hospital, I handled cases like these for a hospital when they came up for a couple of years, because nobody more experienced wanted to deal with these emotionally draining and time consuming conflicts with few monetary rewards for the hospital, and because the stakes from the hospital's perspective were low, so junior associate attorneys could be trusted with this cases. Appellate courts also often frame these decisions as fact bound case by case questions decided under general considerations applicable to all forms of injunctive relief in civil cases, rather than questions presenting more general questions of law to which general policy rules apply. Furthermore, the conceptual foundation in which we think about the authority of different family members over an incapacitated person at common law has shifted materially since the 19th century when these issues started to arise, and mostly hasn't been formally discussed by the courts as applied to these particular situations in the meantime. So, even when there are old precedents governing these situations, there is doubt regarding whether they are still good law, because the old precedents are based upon assumptions about spousal and parental and family member rights that no longer hold in other areas of the law. See also an analysis of issues of visitation and medical decision making for disabled persons, primarily under the federal Americans with Disabilities Act and related regulations, with footnotes particular to Maryland's state laws on the subject. Can E block B, C and D from visiting A in the hospital? What legal authorization form(s) can person A fill out and provide to B, C and D to prevent that from happening if this is a serious concern? The right of a private individual to visit someone in a hospital is usually not codified into law and is usually a matter of hospital policy within reason, acting in the best interests of its patients from a medical perspective. Usually E could only block B, C and D from visiting A in the hospital (1) with the cooperation of the hospital based upon its own policies (since as a practical matter, the hospital is generally in control of the situation and has broad authority to restrict access to its patients for health reasons), or (2) with a restraining order or protective order obtained from a court, or (3) as a legal guardian appointed by a court of person A (who generally has the authority to decide who their ward can interact with). In old common law cases (usually mid-19th century or earlier, but sometime in the early 20th century), the spouse of a married person (sometimes only the husband of a wife, but not vice versa), or the parents of an unmarried minor or unmarried person more generally, had the rights of a legal guardian with respect to an incapacitated person, and a family member had authority to make decisions for an incapacitated person as next of kin, in the absence of a parent or spouse. But, for the most part, this is no longer legally enforceable law. The Married Women's Property Acts of the late 19th century and early 20th century generally eliminated the authority of a spouse to act as legal guardian of an incapacitated spouse without a court order, sometimes subject to cases of &quot;necessities&quot;, and control of personal family property like a marital residence, household goods, or vehicle titled in a spouse's name alone that the competent spouse used in the ordinary course prior to the incapacity. The authority of a parent or next of kin person to take action for an incapacitated person without a court order was largely abrogated by state probate codes establishing court procedures for guardianship and conservatorship appointments for incapacitated people giving spouses, parents and next of kin priority, but not authority in the absence of a court order, except in the case of minor, unmarried, unemancipated minor children. And, even then, it is rare for statutes for expressly grant parents that authority over the children by statute and the authority is merely assumed as background common law to other statutes limiting that authority in cases of child abuse or child neglect, and some kinds of decisions still need court approval even in the case of parents of unemancipated, unmarried minor children. Documents specifically authorizing visitation are rare (I've never seen one in real life outside a civil union of a same sex couple), although states with &quot;civil union&quot; laws enacted before same sex marriage was legalized, often expressly afford a civil union partner visitation rates with priority over other family in hospitals, despite the fact that the status quo law is often ill defined. Hospital policies that denied visitation to de facto civil union partners were an important driving force in causing civil union legislation to be adopted with the support of legislators who didn't have a strong feeling about gay rights as an overall matter and who were otherwise indifferent to the economic rights of civil union matters but adopted the rights of married couples because it was the mindless default way to adopt a body of pre-existing law with little serious thought or fact rich informed deliberation. This is, in part, because visitation is not a matter over which a patient at a hospital has unilateral decision making power. Hospitals generally have their own policies regarding visits to patients. See, e.g.,, discussing the University of Maryland's hospital visitation policy. Usually, a hospital will honor a patient's reasonable request to not allow someone to visit them (out of general respect for patient autonomy). But, a hospital will often decline to allow a patient to have visitors out of concern for the best interests of the health of the patient even when a patient would like to have a visitor (e.g. a hospital would often refuse to allow someone with a recent positive COVID-19 test to enter an Intensive Care Unit (ICU) even if the patient would like to visit that person). Even here, however, the conceptual foundation behind traditional hospital practices related to visitation have shifted. The modern view is to more strongly respect the personal autonomy interests of a hospital patient than hospitals did in the past (the trend started to shift more strongly to a patient autonomy mindset in the late 1950s and gradually shifted toward greater patient autonomy in that time frame, particularly, following the deinstitutionalization of the mentally ill). Hospitals are loathe to create a situation where their express statutory, contractual, and/or common law authority to regulate visitation could be overridden by a patient, and laws related to hospital visitation are rarely adopted by a legislature over the objection of the hospital lobby. What legal authorization form(s) can person A fill out and provide to B and C so that they get precedence in medical decision-making authority over E? Many hospitals would give E priority over B and C and D in making medical decisions for A, if A is incapacitated and there are no court orders or legal documents that provide otherwise, as a matter of policy. And, these policies are often traceable to the mindset associated with the old common law rules that no legal have binding legal effect. But some states have a scheme in which the hospital makes unilateral decisions in the best interests of the patient as they see it, unless B, C, D and E (and possibly other people designated by mutual agreement) jointly agree on who should make those decisions. See, e.g., Colorado Revised Statutes § 15-18.5-103 (Proxy decision-makers for medical treatment authorized--definitions). On paper, Colorado is such a state, although in practice, a hospital would offer listen to a spouse over other family anyway. I don't know if Maryland is such a state. I could not easily locate any statute in Maryland governing medical decision-making authority for an incompetent patient in the absence of a health care power of attorney or the equivalent or a guardianship proceeding, although my search was not exhaustive. A document commonly known either as a medical power of attorney, or a health care power of attorney, or a health care proxy designation made by a competent person who does not have a legal guardian appointed for them at the time, can designate someone such as B and C to have priority over E in making medical decisions for them. This document would be controlling absent a court order to the contrary, and usually a court would give authority to the person named in that document (although a court is almost never required to do so without regard to the suitability of the person seeking court ordered decision making power).
In general property owners and employers can impose any rules on their property and employees (respectively) that are not prohibited by law. Granted, there are extensive statutes and regulations to protect "employee rights." I have not heard of protections that include "possession of prescribed medications," but that does not mean they don't exist in your jurisdiction. If you really want to know whether you have a legal right as an employee, and you can't find it in written law or regulation, you would have to consult regulators or employment law attorneys in your jurisdiction. (As a practical matter, of course, it might make sense to first find out whether one's employer wants to assert a policy infringing the right in question.)
Either party can petition the appropriate court for an adjudication of paternity (if this has not already been established in connection with the issuance of the birth certificate), and for a parental responsibility and child support order, at any time, if no such order is in place (assuming that Pennsylvania is the "home state" of the child and venue is proper). Child custody and visitation rights are determined based upon the "best interests of the child" with very little other formal guidance from the statute or even case law which also affords a judge very broad, although not unlimited discretion in resolving the issue if the parents don't reach an agreement. Any parent who is not adjudicated to be "unfit" (whose parental rights would then be terminated), is entitled to some reasonable visitation under the circumstances at a minimum. In practice, courts tend to prefer to enter an order that preserves the pre-litigation status quo is one was established for any reasonable length of time. Once a custody and visitation schedule are established (logically, this is actually done contemporaneously), a child support award is also entered based upon the number of nights per year that the child spends with each parent, the income of each parent, and the extraordinary expenses, if any of the child, pursuant to guidelines that exist under state law but are federally mandated. Generally speaking, child support payments are quite small relative to the incomes of the parties. If a parent is willfully refusing to work or underemployed so as to reduce child support, in some circumstances, income that could have been earned is imputed to that parent for purposes of determining the appropriate amount of child support. There is a small body of civil procedure that goes to the nitty gritty of how this is handled after a petition is filed, but that really goes beyond the scope of the question. In the simplest case, only the two parents are involved in the litigation. But, there are circumstances in which there can be other parties. For example, if the child has been supported by welfare, a representative of the state is a party to make sure that child support is paid reducing the need for welfare payments or repaying welfare payments already made by the state. Guardians of an un-empancipated minor or disabled parent might participate. Grandparents can sometimes have standing to participate. A non-parent who has physical custody of the child would usually have standing to participate. This all gets a little technical, and since the question doesn't suggest any facts that would call for additional parties, I will leave it at that. In the event of a substantial change of circumstances after a statutory period after the last order was entered, a court may start over, more or less from scratch, and establish a modified child custody, visitation and child support order that reflects the changed circumstances. As a practical matter, for parents who are separated from shortly after the birth of a child and can't work things out between themselves, there will probably be several to half a dozen modification proceedings until the child is an adult.
You're asking about what is generally referred to as the "joint-participant exception." In the United States, the answer varies from jurisdiction to jurisdiction, as each state sets its own rules on which communications are privileged and which are not. Even in the federal courts, where the law should be relatively consistent, there is some disagreement on this question. After the Tenth Circuit recognized the exception in Trammel v. United States, 445 U.S. 40, (1980), the Supreme Court gave a vague statement suggesting that the exception does not exist, but it was not clear enough to settle the question. Since then, the Seventh Circuit has said the exception applies, but the First, Second, Third, and Ninth circuits have said it does not. So until the Supreme Court weighs in again, the answer is "it depends where you live." Keep in mind also that what is often referred to as "spousal privilege" actually encompasses two very distinct privileges: (1) the spousal communications privilege, which is a defendant's right to block testimony about his statements to his spouse; and (2) the spousal testimonial privilege, which is a witness's right to refuse to testify against his spouse. It may be that in some jurisdictions, the joint-participant exception applies to one but not the other.
It is generally understood that governments do have the right to quarantine citizens in case of epidemic outbreaks. In nations with a rule of law, the extent of quarantine regulations may be challenged in court. A challenge against the app has been filed, and trying to second-guess the court by reading sections of the constitution seems to be pointless.
The applicable state law is here. Section 461-A:2 guides the interpretation of the chapter: I. Because children do best when both parents have a stable and meaningful involvement in their lives, it is the policy of this state, unless it is clearly shown that in a particular case it is detrimental to a child, to: (a) Support frequent and continuing contact between each child and both parents. (b) Encourage parents to share in the rights and responsibilities of raising their children after the parents have separated or divorced. (c) Encourage parents to develop their own parenting plan with the assistance of legal and mediation professionals, unless there is evidence of domestic violence, child abuse, or neglect. (d) Grant parents and courts the widest discretion in developing a parenting plan. (e) Consider both the best interests of the child in light of the factors listed in RSA 461-A:6 and the safety of the parties in developing a parenting plan. II. This chapter shall be construed so as to promote the policy stated in this section. The law gets no more specific than to refer to the fact of being a parent. The law does not favor males over females, or vice versa, and the law does not discriminate between a parent who is a minor versus a parent who is a legal adult. The rights of parents are equal, ab initio. However, the recognition of the rights of a father does depend on the legal establishment of paternity whereas the law takes maternity to be self-evident. This may have been dealt with at birth, or may require a legal process if paternity is contested. If that part is sorted out, then disagreements about custody etc. which can't be worked out through agreement possibly with a mediator can be resolved in court. The court will determine what constitutes the "best interests of the child". That is all there is to it, legally. That does not mean that a judge making a decision is absolutely immune from thinking that the minor father is less able take care of the child. Starting next year, a minor can seek emancipation, but until then (and until there is emancipation), the minor's parent have veto power over the father's wishes.
A trust, revocable or irrevocable, does not protect the estate from claims by creditors. Under ORS 115.125(1)(k), the Department of Human Services or the Oregon Health Authority has a claim against the estate, behind the claim for "the state’s monthly contribution to the federal government to defray the costs of outpatient prescription drug coverage provided to a person who is eligible for Medicare Part D prescription drug coverage and who receives benefits under the state medical assistance program or Title XIX of the Social Security Act" (which is item (j)) and ahead of only the claim by the Department of Corrections for care and maintenance of any decedent who was at a state institution – that one is dead-last in the list of statutorily-listed claims.
Note that I am not a lawyer. All law code here is from the official Georgia Law at LexisNexis. In the case of Georgia, the law regarding a child’s election changed in 2008. Prior to 2008, a 14 year old child could choose with which parent to live, unless the judge determined that the chosen parent is unfit. As proving that a parent is unfit was not always easy, the Georgia General Assembly in 2008 replaced the unfit parent standard with a Best Interests of the Child Standard. This new standard provides more flexibility to the judge in determining custody. Some basic facts about how the law in relation to the child's selection of parent: A parent that wishes to modify an existing custody arrangement must show that a material change in circumstances has occurred that warrants a new decision by the court. If the child is 14 then the child's desire to select the parent may be considered as the "material change in circumstances". However the court will only consider the child's choice if at least two years have passed since the last custody determination. These aspects of the law can be seen in Georgia statute 19-9-3, article 5, which states: (5) In all custody cases in which the child has reached the age of 14 years, the child shall have the right to select the parent with whom he or she desires to live. The child's selection for purposes of custody shall be presumptive unless the parent so selected is determined not to be in the best interests of the child. The parental selection by a child who has reached the age of 14 may, in and of itself, constitute a material change of condition or circumstance in any action seeking a modification or change in the custody of that child; provided, however, that such selection may only be made once within a period of two years from the date of the previous selection and the best interests of the child standard shall apply. Note that the expression "The child's selection for purposes of custody shall be presumptive unless..." is the same as saying that "the child's selection shall be controlling (the decision) unless...". As to children that are between 11 and 14 the law states as follows (Georgia statute 19-9-3, article 6) (6) In all custody cases in which the child has reached the age of 11 but not 14 years, the judge shall consider the desires and educational needs of the child in determining which parent shall have custody. The judge shall have complete discretion in making this determination, and the child's desires shall not be controlling. The judge shall further have broad discretion as to how the child's desires are to be considered, including through the report of a guardian ad litem. The best interests of the child standard shall be controlling. The parental selection of a child who has reached the age of 11 but not 14 years shall not, in and of itself, constitute a material change of condition or circumstance in any action seeking a modification or change in the custody of that child. The judge may issue an order granting temporary custody to the selected parent for a trial period not to exceed six months regarding the custody of a child who has reached the age of 11 but not 14 years where the judge hearing the case determines such a temporary order is appropriate. (Note that a "guardian ad litem" is the same as a "legal guardian".) If the child is younger than 11, there is no expectation for the judge to consider the child’s preference when awarding custody. Besides the desire of the child, the judge may consider following factors listed under Georgia statute 19-9-3, article 3: (3) In determining the best interests of the child, the judge may consider any relevant factor including, but not limited to: (A) The love, affection, bonding, and emotional ties existing between each parent and the child; (B) The love, affection, bonding, and emotional ties existing between the child and his or her siblings, half siblings, and stepsiblings and the residence of such other children; (C) The capacity and disposition of each parent to give the child love, affection, and guidance and to continue the education and rearing of the child; (D) Each parent's knowledge and familiarity of the child and the child's needs; (E) The capacity and disposition of each parent to provide the child with food, clothing, medical care, day-to-day needs, and other necessary basic care, with consideration made for the potential payment of child support by the other parent; (F) The home environment of each parent considering the promotion of nurturance and safety of the child rather than superficial or material factors; (G) The importance of continuity in the child's life and the length of time the child has lived in a stable, satisfactory environment and the desirability of maintaining continuity; (H) The stability of the family unit of each of the parents and the presence or absence of each parent's support systems within the community to benefit the child; (I) The mental and physical health of each parent; (J) Each parent's involvement, or lack thereof, in the child's educational, social, and extracurricular activities; (K) Each parent's employment schedule and the related flexibility or limitations, if any, of a parent to care for the child; (L) The home, school, and community record and history of the child, as well as any health or educational special needs of the child; (M) Each parent's past performance and relative abilities for future performance of parenting responsibilities; (N) The willingness and ability of each of the parents to facilitate and encourage a close and continuing parent-child relationship between the child and the other parent, consistent with the best interest of the child; (O) Any recommendation by a court appointed custody evaluator or guardian ad litem; (P) Any evidence of family violence or sexual, mental, or physical child abuse or criminal history of either parent; and (Q) Any evidence of substance abuse by either parent.