Massachusetts Health Decisions (MHD) is a nonprofit, non-partisan organization that provides both public and professional education on ethical issues in health care. MHD works collaboratively with health care organizations, clinical and administrative staff, educators, and members of the public to develop programs that benefit people who provide care and those who receive it.
Community Town Meetings
MHD began operation in late 1988 as one of 15 similar community health decisions programs nationwide–all of which received 501(c)(3) recognition. Between 1988 and its incorporation in 2007, MHD was a program of Third Sector New England, Inc.(TSNE), formerly the Massachusetts Health Research Institute, itself a 501(c)(3) since the 1960s. TSNE provided administrative and logistical support and served as MHD’s fiscal agent for almost 20 years. An unusually talented board of advisors guided MHD’s activities since inception. As Executive Director of MHD, David Clarke has been an independent contractor providing program services for MHD.
From 1989 until 1994, MHD conducted community “town meeting” discussion groups throughout Massachusetts as an effective and non-partisan way to enable citizens to become more aware of and involved in critical health care issues. Discussions were led by trained volunteers and participants registered their opinions on anonymous surveys. Results of more than 1500 such surveys were shared with health care administrators, policy makers and state legislators to inform them of community values on such issues as funding for health care, organ donation and transplantation, care at the end of life, and other critical issues. MHD took no position on the issues discussed, and trained discussion leaders were encouraged to seek out a range of issues in participating audiences. The two large-scale public discussion programs were supported by grants and contributions.
Massachusetts Health Care Proxy
In 1991, MHD convened and staffed the Massachusetts Health Care Proxy Task Force, a two-year effort to implement the state’s new advance directive law. MHD has published the most widely used Health Care Proxy form constantly since 1991 and makes it available in 15 languages to meet the needs of non-English speaking citizens. MHD continues to make the form available on request to all members of the public. Quantity sales of forms and associated materials to health care facilities and organizations have provided modest income to fund a variety of education programs for members of the public as well as health care professionals. MHD is the only organization in Massachusetts that provides regular consultation for health care professionals on Health Care Proxy use and implementation issues.
The Proxy Task Force also wrote the statement of Massachusetts law that health facilities are required to distribute to all patients according to the 1991 federal Patient Self Determination Act. The Commissioner of the state Department of Public Health later sent this statement to all licensed health facilities in the state. The work of the Task Force—as a wholly voluntary and collaborative effort of 16 statewide organizations—was nationally unprecedented. The ‘Boston Globe’ called the Task Force a “model” for cooperation between state and private agencies. (1)
Since 1989, MHD has conducted more than 250 education programs on advance directives and health care decision making to senior centers, religious and fraternal organizations, business and community groups, as well as health care organizational staff throughout Massachusetts. MHD continues to be the lead resource available for telephone and personal consultation on this issue.
From 1991 until present, MHD has been an active participant in the following programs:
• MHD worked with the regional and national American Association of Retired Persons (AARP) to train AARP volunteers to be good educators of AARP members and the general public on advance directives
• MHD worked with the Massachusetts Department of Public Health, Office of Emergency Medical Services (1998 – 2000) to develop the “Comfort Care” program that provides a strict protocol for how ambulance drivers and EMTs should respect the wishes of dying persons being transported between their home and the hospital
• MHD worked with the Massachusetts Department of Mental Health (2002 – 2003) to create the nationally acclaimed program “Do It Your Way: End-of-Life Care for Persons with Serious Mental Illness”. See: http://online.liebertpub.com/doi/abs/10.1089/109662103768253830?journalCode=jpm
• MHD was a standing member of the Advance Directives Committee of the Massachusetts Medical Society (1994 – 2002), and served as lead trainer of a program to encourage private practice family physicians to introduce their patients to the concept of advance directives and advanced care planning.
Continuing Professional Education
From 1994 until 2001, MHD developed and sustained a unique cooperative program to train members of health care ethics committees—people who serve as resources for patients, family members, and health care providers in need of a “sounding board” for their health care treatment dilemmas. The resulting Bioethics Cooperative and associated Ethics Committee Tutorial were sustained by individual and organizational membership fees. Quarterly statewide conferences were held and were designed to be cost neutral. Average conference attendance was 90 for more than five years.
Beginning in 1994 and continuing through 2012, MHD offered continuing professional education programs aimed at improving the relationship between patients and clinicians by enhancing clinicians’ communication skills. The programs addressed such issues as care at the end of life, breaking bad news, disclosing unexpected outcomes and medical errors, and how to talk most effectively with patients and their families in the emergency room setting. These programs were extremely well received and extended MHD’s reach into neighboring New England states. The California Board of Registered Nursing has certified MHD as a Continuing Education Provider of programs for nurses. Certification is current.
In 2008, MHD developed with American Health Decisions and hosted a national conference entitled: “The Patient Alone: Making Health Care Choices for Patients Without Surrogates.” The 2-day program was designed to help health care professionals and organizations care for patients who have no family or close friends and who might require informed consent or refusal by a substitute decision maker. Presenters came from the American Bar Association Commission on Legal Problems of the Elderly; Harvard Medical School; the California Alliance for Catholic Health Care; the New York State Surrogate Decision Making Committee; the University of Connecticut School of Medicine; the Veteran’s Health Administration; The Hastings Center; and other nationally known health, law, and ethics organizations. Materials from this AHD conference are available on this site.
In 2014, MHD initiated a unique effort to help fund distinctive health education programs and projects developed by other organizations whose missions were consistent with MHD’s own goals. The new grant program, Health Decisions Resources (HDR), was made possible by a bequest from Dr. Ivor and Mrs. Margaret Cornman, long-time residents of Woods Hole, Massachusetts and enthusiastic supporters of the work of Massachusetts Health Decisions for more than twenty years.
‘Pioneers Encourage Tackling the Tough Health-care Choices,’ The Boston Globe, July 15,
Some material above excerpted from IRS Tax Exemption Application, Form 1023, June 2007. The IRS granted tax exemption to MHD under Section 501(c)(3) of the Internal Revenue Code, effective May 17, 2007, MHD’s date of incorporation as a Massachusetts charitable corporation.