Advance Directives

A healthcare proxy (sometimes called a healthcare “agent”) is someone who can be your voice if you’re ever unable to make or express healthcare decisions yourself. It’s up to you to pick your healthcare proxy. This person can make sure your care providers know what matters to you if you become unable to speak for yourself.

It’s never too soon to choose a proxy. Everyone 18 years of age and older — people who are healthy as well as those who are sick — should complete a healthcare proxy form. Many serious health problems come up unexpectedly. Think of the proxy as a type of insurance: You hope you never need it, but if you do, it’s important that you’re prepared.

Your healthcare proxy should be someone who understands and respects your values and wishes regarding your health. They also should be someone willing and able to communicate those values and wishes to your healthcare providers, even if this is difficult. It is often a spouse or a close family member, but it doesn’t have to be. You are free to name almost anyone you choose as your proxy.

There are only a few rules about people you may not name:

• You may not name someone under 18 years old.
• If you are currently a patient at a healthcare facility, you may not name an employee of that facility as your agent (unless the person is a relative).
• You may not name a member of your current care team. For example, a doctor or nurse cannot provide care for you and serve as your proxy at the same time.

No. A Massachusetts Healthcare Proxy Form can be filled out any time. You do not need a lawyer or notary. Also, the person you name as the proxy (or alternate) does not need to be present and does not need to sign the form.

Yes. For the form to be complete, it must be signed by you (or your authorized representative) and witnessed by two adults. The witnesses cannot be the proxy or alternate proxy. Ideally your witnesses should be people you know. But if needed, hospital staff may serve as witnesses. (If they do, they should give their work address on the form.) A photocopy of the form is just as valid as the original.

Yes. A healthcare proxy isn’t the same as a living will or other forms people may use to outline their wishes. While living wills and other planning forms are useful tools, they cannot cover every situation that may arise or every decision that may need to be made.

That’s why having a proxy is so important. The proxy can be your voice and can speak for you no matter what healthcare decision needs to be made. Also, in Massachusetts, if you cannot make or express your own healthcare decisions, a completed healthcare proxy form is the only legally binding document regarding your health.

In Massachusetts, you may name one 'primary' proxy and an 'alternate' proxy. The alternate person would only step in if your primary proxy was unavailable or was unable or unwilling to serve.

Yes. A larger circle of family and friends can be involved in decisions about your care. In fact, people who are close to you might be extremely helpful if your proxy needs to make difficult choices about your care. Talking to your proxy about who should be part of this process is important. Still, in the end, your healthcare team will look to your proxy to speak for you.

If a family member doesn’t agree with care plans that are being made or believes that your proxy is not carrying out your wishes, he or she may go to court to legally challenge your proxy’s decisions.

Your proxy makes decisions for you only after your doctor has said that you aren’t able to make or express decisions about your care. This is done based on standards of medical practice. Once your proxy begins making decisions for you, your proxy will have access to any medical information that you would have access to yourself. Your proxy speaks for you only if you are unable to communicate your wishes. If your doctor says that your ability to speak for yourself has returned, your proxy no longer speaks for you.

You may change your mind at any time. Be sure to tell your healthcare team about the change. Your signed proxy form will be cancelled if:

• You fill out a new form later.
• You legally separate from or divorce your spouse, and your spouse was named as your agent. (If you wish to use that person as your proxy, you may do so if the form naming them as your proxy was completed after your separation or divorce date).
• You tell your agent, doctor or other healthcare provider — verbally or in writing — that you changed your mind about your proxy.

You don’t need a healthcare proxy to receive care. But if you don’t have one, your healthcare providers will automatically turn to your family for guidance regarding your wishes. If you haven’t told them what you would want in a particular situation, they will be left to guess. This may be a difficult burden for them, and they may not make the decisions you would want them to make. You can help prevent your loved ones from suffering unnecessary stress and anxiety by selecting a proxy and having a conversation ahead of time about your care.

Also, if you don’t have a healthcare proxy, certain decisions about your care may need to be addressed in court. For example, this may happen if your family cannot be reached or disagrees about the course of your care. Also, nursing home placement cannot occur without a proxy or court-appointed guardian.

If you go to another hospital in Massachusetts and you have a copy of your proxy form, you don’t need to fill out a new form. If you go to a hospital in another state, your proxy form will be honored in most cases.