The Health Care Proxy

The Massachusetts Health Care Proxy is a simple legal form that allows you to name someone you trust to make health care decisions for you, according to your wishes, if—for any reason and at any time—you become unable to make or communicate those decisions yourself.

Why is there a Health Care Proxy?

Under Massachusetts and U.S. law, you have basic rights to decide about your own health care. These include a right to be told about your illness, the treatment that your doctor is recommending, along with its possible risks and benefits, and the right to freely say yes or no to any treatment. You have these rights at all times, and they apply to all recommended treatments, even treatments that could keep you alive.

If you become ill or have an accident, and you become unable to make your own health care decisions, you don’t lose those rights. But in order to make them work, they will have to be put into action by someone else. The Health Care Proxy Law allows you to choose the person who will exercise your right to make your own health care decisions. That person is called your Health Care Agent. The law allows you to name someone you trust to discuss possible treatment choices with your doctor and then decide the best treatment for you—according to your wishes or in your best interests.

Who can complete a Health Care Proxy?

Any competent adult age 18 or over has the right to complete his or her own Health Care Proxy. As a rule of thumb, the law considers you to be a competent person unless a judge has ruled that you are legally incompetent to act in your own best interests.

Once I sign the Proxy, does that mean I can no longer make health care decisions myself?

No. The Proxy becomes a legal document when you sign the Proxy and two witnesses sign that they saw you sign the document yourself. But your Agent cannot act for you until your doctor states, in writing, that you are not able to make health care decisions for yourself. The doctor will then ask the person you named in your Proxy if they are willing to make decisions on your behalf. If you later get well, you will again make your own decisions. Your Agent makes decisions for you only when and for as long as you cannot do that for yourself.

Can I change my mind?

Yes, anytime and for any reason. If you name a person to be your Agent, and later change your mind, just sign and date a new Proxy. The old one is automatically revoked or cancelled. If you disagree with what your Agent is asking your doctor to do, you should say so.

Is the Health Care Proxy legal in Massachusetts?

Yes. The Health Care Proxy Law was passed in 1990 (Massachusetts General Laws, Chapter 201D). The form published by nonprofit Massachusetts Health Decisions meets all legal requirements and was developed by MHD with help from a Task Force of the 15 statewide organizations listed on the Proxy. It is used by hospitals, health plans, nursing homes, hospices, and other health care facilities. Because it is the most widely used form in Massachusetts, we will refer to it throughout this website.

Is the Health Care Proxy the same as an Advance Directive?

“Advance Directive” is the general term for several legal documents that tell your doctor and other people what your health care wishes are if you become unable to make your own health care decisions.

What kind of advance directive is honored in your state depends on your state’s law. Some states have more than one directive. There is no one form that can be used in every state. Advance directives include:

  • the Health Care Proxy, also called a Health Care Power of Attorney or Durable Power of Attorney for Health Care
  • the Living Will, also called a Natural Death Declaration, Medical Treatment Declaration, Terminal Care Document, etc.

Why are advance directives important?

Advance directives are an important part of planning for your health care because they put your values and wishes into a legally binding document or into the hands of someone you trust. If you cannot make decisions about your care because you are ill or have been in an accident, your directive will help your health care provider to respect your wishes.

Without a directive, your doctor will turn to your spouse or family member who may have the legal authority to consent to or refuse treatment for you. If there is disagreement among the members of your family (or if you don’t have a family), your doctor will have to ask a court to name a legal guardian to make choices for you.

If you enroll in a health plan, or are admitted to a hospital, nursing home, hospice, or home health agency, they will give you information about advance directives. But the choice to fill one out is yours alone. If you do complete one, and later change your mind, you can cancel it at any time.

If you decide to complete any advance directive, it is very important to talk with your doctor or other members of your health care team, your Agent (the person you choose as decision maker), and with other people who may be involved with your care. The time to think and talk about your health care choices is before you need to depend on the directive.

How are the advance directives different?

A Health Care Proxy or Health Care Power of Attorney lets you choose someone you trust to make health care decisions for you. It usually becomes effective only if and when you become unable to make or communicate your own health care decisions. It lets your doctor and others know whom to ask to find out what your wishes would be in a particular situation.

The person you choose, called your Agent, will have full legal authority to make any and all health care decisions for you, including decisions about life-sustaining treatment if you wish. He or she can decide for you only when you cannot decide for yourself. Your Agent must act according to your wishes or in your best interests.

Because the Health Care Proxy applies to all health decisions, and not just to decisions at the end of life, it is important for you to talk with your Agent about issues important to you. For example, you might discuss how you would feel about having constant pain, what it would mean to you to have a permanent mental disability, or how your religious beliefs or moral code would guide your decisions.

No one can predict what might happen in the future. But if the time comes when you must depend on another person to make decisions about your care, that person will have to know what is important to you in order to make the best choices for you.

A Living Will is a written statement you give to your doctor and family members. It says that if you become terminally ill or there is no reasonable hope for your recovery, that you wish to avoid medical treatments that would only prolong the time of death and do not offer any hope of cure. Most documents say that you wish to be given all treatment necessary to keep you comfortable. Some Living Wills have checklists of treatments you do or don’t want in certain situations. Others have blanks where you can write in your specific wishes.  The Living Will is not specifically recognized by Massachusetts law.

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