Table of Contents
- Download a Massachusetts Health Care Proxy Sample
- What is a Massachusetts Health Care Proxy Form?
- Who Should Have a Massachusetts Health Care Proxy?
- How to Select Your Agent(s)
- Decision Making Power of Your Agents
- What to Do if You Change Your Mind
- How to Complete Your Massachusetts Health Care Proxy
1. Download a Massachusetts Health Care Proxy Sample
Your Free Massachusetts Health Care Proxy Download
2. What is a Massachusetts Health Care Proxy Form?
A Massachusetts Health Care Proxy, as specified in Chapter 201D of the Massachusetts General Laws, is a document that appoints someone you trust to make healthcare decisions on your behalf—in the event that you lose the ability to make such decisions yourself.
In such a circumstance, the person you appoint in your Health Care Proxy will ensure that healthcare providers (such as hospitals, doctors, nurses, and any other entity making choices about your medical care) will follow your agent’s instructions as if they were your own. Put simply, a completed Massachusetts Health Care Proxy Form will answer these vital questions:
- Who will carry out my medical wishes, in the event that I’m unable to communicate them?
- What type of treatment do I want to receive?
- What treatment do I not want to receive?
- Will my religious, moral, or other beliefs be followed in my treatment?
Below are a few key terms to keep in mind before filling out a Health Care Proxy form, as laid out in M.G.L. ch.201D §1:
- Principal: The person who has completed a Health Care Proxy.
- Health Care Agent: An adult who has been chosen by a Health Care Proxy to make health care decisions for the principal.
- Health Care: Any treatment, procedure, or service to diagnose and/or treat a person’s mental or physical condition.
- Health Care Provider: A person or facility licensed and authorized to administer health care.
- Health Care Decision: Any decision to consent to or refuse health care.
It’s important to note that a health care proxy form is can also be referred to as:
- Health Care Power of Attorney
- Medical Power of Attorney
3. Who Should Have a Massachusetts Health Care Proxy?
No matter your age or health, being prepared for sudden, unforeseen medical events is vital. It can be difficult to contemplate, but a situation could arise in which you are unable to communicate your wishes when it comes to your medical care. Such predicaments could include (but are not limited to):
- Being unable to communicate due to a coma,
- Developing a form of dementia, such as Alzheimer’s, leaving you unable to convey rational thoughts
- Being in an indefinite vegetative state
- An unexpected complication occurs while under anesthesia
- Developing a terminal illness
Should such a condition occur, a Health Care Proxy will ensure that you’ll be treated according to your own wishes. The document, by laying out your exact desires, can also greatly assist your family with the enormous responsibility associated with making hard choices for sick loved ones.
4. How to Select Your Agent(s)
Choosing who to appoint as your agent is, of course, a critical and extremely personal decision. You should appoint someone who you feel confident will have your best interest, as well as your personal desires and convictions, in mind. It’s also important that the agent be someone who will have the ability to carry out your directives in the midst of a difficult, painful situation. You should, of course, discuss the matter with your proposed agent beforehand.
Who can you select as your agent?
As specified in M.G.L. ch.201D §2, you may choose any adult age 18 or older as your agent, even a non-family member, with certain restrictions as outlined below. They could be your spouse, domestic partner, son or daughter, parent, sibling, attorney and more.
Who can you not select as your agent?
You can’t choose an operator, administrator or employee of a healthcare facility (such as a hospital or nursing home) as your agent while you are a patient or resident of the facility, unless you are related by blood, marriage or adoption (M.G.L. ch.93A §3).
Can you have more than one agent?
Yes. Per M.G.L. ch.201D §2, you can choose one person as your primary agent and one person as an alternate, in case your first choice is unavailable or unwilling to act as your agent.
5. Decision Making Power of Your Agents
What Health Care Decisions is Your Agent Able Make on Your Behalf?
M.G.L. ch.201D §5 states that your agent will have the authority to make all health care decisions for you, and your health care providers are required to honor the agent’s decisions as if they were your own. Such choices can include (but are not limited to):
- Whether to administer life support if you are in a coma
- When to continue or discontinue treatments
- What type of treatment will be administered
- Organ donation decisions
What Health Care Decisions is Your Agent Unable to Make on Your Behalf?
Your agent can make any decisions regarding your health care, unless you explicitly limit the decisions they are able to make within your Massachusetts Health Care Proxy form (M.G.L. ch.201D §5).
Your agent does not have the power to make decisions unrelated to your health care, such as financial decisions (for which a Massachusetts general power of attorney would be more appropriate).
When is Your Agent Able to Begin Making Decision on Your Behalf?
Your agent can begin to make health care decisions once your doctor concludes, in writing, that you’re unable to make your own health care decisions (M.G.L. ch.201D §6). Therefore, as long as your doctor believes you’re capable of making your own health care decisions, your decisions supersede the decision-making power of your agent.
6. What to Do if You Change Your Mind
How Long is Your Health Care Proxy Effective?
Your Health Care Proxy is valid and enforceable as long as you’re alive, unless you change or cancel it as outlined below.
How to Revoke a Health Care Proxy
As laid out in Section 7 of M.G.L. 201D, you can revoke your Health Care Proxy in a few different ways:
- Sign a new Massachusetts Health Care Proxy or formal Revocation of Power of Attorney form
- Notify your agent or health care provider, either orally or in writing, that you want to revoke your Health Care Proxy
- Do any other act showing a specific intent to revoke the Health Care Proxy, such as tearing up the form, crossing it out, telling other people that you wish to revoke the Health Care Proxy, etc.
Additionally, if you name a spouse as your agent, it’s important to note that your Health Care Proxy will be revoked automatically if you become divorced or legally separated.
7. How to Complete Your Massachusetts Health Care Proxy
Do You Need a Witness / Notary Public Signatures?
Per M.G.L. ch.201D §2, to complete a Health Care Proxy you only need two competent adults (18 years of age or older) to witness your signature and sign the document. Note that the person you assign as your agent cannot be a witness. Massachusetts does not require that the document be notarized.
What to Do With Your Signed Health Care Proxy
Once you’ve completed a Health Care Proxy, you should give a copy to your agent, your doctor, your attorney, as well as other family members, friends or acquaintances as you see fit.
You may also want to consider keeping a copy on your person (such as in a wallet or purse) or with other important personal documents. You should bring a copy with you if you are admitted to the hospital, even for minor surgery or outpatient procedures.
