The healthcare proxy is a simple legal document that allows you to name someone you know and trust to make healthcare decisions for you if, for any reason and at any time, you become unable to make or communicate those decisions. It is an important document, however, because it concerns not only the choices you make about your healthcare, but also the relationships you have with your physician, family, and others who may be involved with your care.
Under the Massachusetts healthcare proxy law any competent adult 18 years of age or over may use a healthcare proxy form to appoint a healthcare agent. You can appoint any adult except the administrator, operator, or employee of a healthcare facility, such as a hospital or nursing home where you are a patient or resident, unless that person is also related to you by blood, marriage, or adoption. Whether or not you live in Massachusetts, you can use this form if you receive your healthcare in Massachusetts.
Your agent will make decisions about your healthcare only when you are, for some reason, unable to do that yourself. This means that your agent can act for you if you are temporarily unconscious, in a coma, or have some other condition in which you cannot make or communicate healthcare decisions. Your agent cannot act for you until your doctor determines, in writing, that you lack the ability to make healthcare decisions.
Acting with your authority, your agent can make any healthcare decision that you could, if you were able. If you give your agent full authority to act for you, he or she can consent to or refuse any medical treatment, including treatment that could keep you alive.
Your agent will make decisions for you only after talking with your doctor or healthcare provider, and after fully considering all the options regarding diagnosis, prognosis, and treatment of your illness or condition. Your agent has the legal right to get any information, including confidential medical information, necessary to make informed decisions for you.
“Your agent will make healthcare decisions for you according to your wishes or according to his or her assessment of your wishes, including your religious or moral beliefs.”
Your agent will make healthcare decisions for you according to your wishes or according to his or her assessment of your wishes, including your religious or moral beliefs. You may wish to talk first with your doctor, religious advisor, or other people before giving instructions to your agent. It is very important that you talk with your agent so he or she knows what is important to you. If your agent does not know what your wishes would be in a particular situation, they will decide based on what they think would be in your best interest. After your doctor has determined that you lack the ability to make healthcare decisions, if you still object to any decision made by your agent, your own decisions will be honored unless a court determines that you lack capacity to make healthcare decisions.
Your agent’s decisions have the same authority as yours would, if you were able, and will be honored over those of any other person, except for any limitation you yourself made, or except for a court order specifically overriding the proxy. However, setting limits on your agent’s authority might make it difficult for your agent to act for you in an unexpected situation.
Before you sign, be sure you have two adults present who will be witnesses and watch you sign the document. The only people who cannot serve as witnesses are your agent and alternate agent. Then sign and date the document yourself. Have your witnesses fill in the date, sign their names, and print their names and addresses.
On the back of the form are statements to be signed by your agent and any alternate agent. This is not required by law, but is recommended to ensure that you have talked with the person or people who may have to make important decisions about your care and that each of them realizes the importance of the task they may have to do.
After you have filled in the form, remove this information page and make at least four photocopies of the form. Keep the original yourself where it can be found easily (not in your safe-deposit box). Give copies to your doctor and/or health plan to put into your medical record. Give copies to your agent and any alternate agent. You can give additional copies to family members, your clergy and/or lawyer, and other people who may be involved in your healthcare decision making.
Your healthcare proxy is revoked when any of the following four things happens: you sign another healthcare proxy later on; you legally separate from or divorce your spouse who is named in the proxy as your agent; you notify your agent, your doctor, or other healthcare provider, orally or in writing, that you want to revoke your healthcare proxy; or you do anything else that clearly shows you want to revoke the proxy — for example, tearing it up or destroying it, crossing it out, or telling other people of your wishes.
Information provided by the Massachusetts Medical Society.