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Healthcare Proxy and Advance Directives

Healthcare can require some very difficult decisions. In situations where you are unable to speak for yourself, a family member or other person will need to make decisions about your medical care. However, your loved ones can't act on your wishes unless they know what they are.

The healthcare proxy, MOLST, and advance directive (or living will) are three documents that allow you to give direction to medical personnel, family, and friends concerning your future care when you cannot speak for yourself.

Forms to Download

Healthcare Proxy

A simple legal document allowing 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. Download the form in English
Download the form in Spanish
Download the form in Russian

MOLST (Massachusetts Medical Orders for Life-Sustaining Treatment)

A medical form that communicates your decisions regarding life-sustaining medical treatments. Learn more and download the form. As of April 3, 2020 (per the Massachusetts Department of Public Health), a MOLST can also be provided with a witnessed and documented verbal consent in place of an actual signature on a patient’s MOLST form when physical signatures are impossible to obtain.

Advance Directive

Also known as a living will, this document states your wishes regarding end-of-life medical care, including the treatments you do and do not want. Learn more and see examples.

Resources for Advance Planning

Frequently Asked Questions

Healthcare Proxy

Q: What is a Healthcare Proxy?
A: A 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. 

Q: Do I need a lawyer to complete a Healthcare Proxy?
A: No, you do not need a lawyer. This document is provided free of charge. You need two witnesses when completing the form, which does not need to be notarized.

Q: Who can be a Healthcare Proxy?
A: You can appoint anyone who is age 18 or older and who is not your doctor or healthcare provider. Your healthcare proxy should be someone you trust, who knows you well enough to know what treatment decisions you would make for yourself. You should discuss your wishes with your proxy in advance.

Q: When would my Healthcare Proxy go into effect?
A:
The health care proxy would take effect ONLY if and when your attending physician makes a written determination that you lack the capacity to make or communicate health care decisions.

Q: What decisions can my Healthcare Proxy make?
A:
Your healthcare proxy will be in charge of making health care decisions on your behalf. In other words, they will speak for you and carry out your wishes.

Q: What do I do with the Healthcare Proxy once it is completed?
A:
Make copies of the completed form and give them to your health care proxy, your primary care provider, and to anyone who will be involved in making medical decisions for you in the event you are unable to make them for yourself.

Q: What if I change my mind?
A:
If you decide that you do not want a healthcare proxy or would like someone else to be your proxy, you may revoke the proxy form by destroying it, signing a new one, and notifying all those who have copies.

Living Will

Q: What is a Living Will?
A:
A Living Will is a written legal document that allows you to list medical treatments that you would or would not want if you became terminally ill and unable to make your own decisions.

Q: What type of wishes concerning medical treatment does this allow me to document?
A: It allows you to document the following wishes concerning your medical treatment:

  • Resuscitation
  • Mechanical ventilation
  • Tube feeding
  • Dialysis
  • Antibiotics or antiviral medications
  • Comfort care (palliative care)
  • Organ and tissue donations
  • Donating your body

Q: Will a Living Will be honored in the state I live in?
A:
Laws differ from state to state. For example, Connecticut recognizes Living Wills. However, Massachusetts law allows people to make their own Health Care Proxies, but does not officially recognize Living Wills. The Personal Wishes form is the alternative for MA residents.

Q: Why should I have a Living Will?
A:
A Living Will relieves the burden of making end-of-life decisions by letting your loved ones know your wishes. Living Wills, even in Massachusetts, are useful because they inform proxies and physicians of choices you would make.

Q: Do I need a lawyer to complete a Living Will?
A:
You do not need a lawyer to complete a Living Will. However, it does require two witness signatures (non-relation) and/or a notary. The Living Will form is available free of charge.

Durable Power of Attorney

Q: What is a Durable Power of Attorney?
A:
The Durable Power of Attorney (DPOA) for healthcare is given to the person you want to make medical, legal, and financial decisions for you in an emergency.

Q: Why would I need a Durable Power of Attorney?
A:
A Durable Power of Attorney is important because without one, your family and friends would not be allowed to make financial decisions, pay bills, or make health care decisions on your behalf if you became incapacitated or incompetent.

Q: Who do I appoint to be my Durable Power of Attorney?
A:
You can appoint anyone who is age 18 or older and who is not your doctor or healthcare provider.

Q: What is the difference between a Durable Power of Attorney and a Living Will?
A:
The Durable Power of Attorney for healthcare authorizes someone to make decisions about your healthcare if you cannot act for yourself. A Living Will simply states your wishes to have certain types of care.

Q: Can I change my mind about my Durable Power of Attorney?
A:
Yes, you can change your mind. If you do, you should destroy all copies of the original form and tell anyone who might have a copy that you changed your mind. You then need to make a new Durable Power of Attorney that reflects your current wishes and agent.

Q: Do I need an attorney to complete the Durable Power of Attorney?
A:
No, you do not need an attorney. It must be notarized and/or have two witnesses.

Q: Can all medical professionals honor a Durable Power of Attorney?
A:
No, emergency medical technicians cannot honor a durable or medical power of attorney.

Medical Order for Life-Sustaining Treatment (MOLST)

Q: What is the MOLST form?
A:
MOLST is a medical order form (similar to a prescription) that relays instructions between health professionals about a patient’s care. MOLST is based on your preferences to accept or refuse medical treatment, including treatments that might extend life.

Q: What does “Life-Sustaining Treatment" mean?
A:
Life-sustaining treatment is treatment that keeps a person alive. This can mean CPR, ventilator, feeding tube, etc.

Q: Who needs a MOLST?
A:
Persons of any age (including children, young adults, elderly) with advanced illnesses or injuries, who want to express their end-of-life preferences.

Q: What is the process for filling out a MOLST form?
A:
It starts with a conversation between the patient, the caregivers (family) and a clinician (physician, nurse practitioner, physician assistant) about advanced care planning. The conversation should include talking about the individual's health status, prognosis, personal values and goals of care, and potential benefits and burdens of treatments. If a MOLST is medically indicated, the clinician will complete this.

Q: Is the MOLST the same as the Health Care Proxy form?
A:
No. A Health Care Proxy form is used to name a person’s health agent in the instance where that person cannot make medical decisions themselves. The MOLST is for clinical staff (physicians, nurse practitioners, physician assistants, EMTs).

Five Wishes

Q: What is the Five Wishes form?
A:
The Five Wishes form is America’s most popular Living Will because it's written in everyday language and helps people express their wishes in areas that matter most to them (personal, spiritual, medical and legal).

Q: How is the Five Wishes form different from the Living Will or Durable Power of Attorney?
A:
The Five Wishes form combines the language from the Living Will/Personal Wishes and the Durable Power of Attorney into one form.

Q: Is this form legal where I live?
A:
The Five Wishes form meets all legal requirements in 42 states, including Massachusetts and Connecticut.

Q: What does “Five Wishes” mean?
A:
The form covers five key areas:

  • Wish 1: The person I want to make care decisions for me when I can’t.
  • Wish 2: The kind of medical treatment I want or don’t want.
  • Wish 3: How comfortable I want to be.
  • Wish 4: How I want people to treat me.
  • Wish 5: What I want my loved ones to know.

Q: Where can I get a Five Wishes form?
A:
The Five Wishes form is available at the Aging with Dignity website for a charge of $5.00 per form.