Health Care Proxy
Click here to download the Health Care Proxy form.
What does the Massachusetts Health Care Proxy Law allow?
The Health Care Proxy is a legal document that allows you to name someone to make health care 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 health care, but also the relationships you have with your physician, family, and others who may be involved with your care. Read this and follow the instructions to ensure that your wishes are honored.
Under the Health care Proxy Law (Massachusetts General Laws, Chapter 201D), any competent adult 18 years of age or over may use this form to appoint a Health Care Agent. You (the “Principal”) can appoint anyone EXCEPT the administrator, operator, or employee of a health care 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.
What can my Agent do?
Your Agent will make decisions about your medical or mental health care 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 medical or mental health condition in which you cannot make or communicate health care decisions. Your Agent cannot act for you until your doctor determines, in writing that you lack the ability to make health care decisions.
Acting with your authority, your agent can make any health care 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 decisions about life-sustaining treatment.
Your agent will make decisions for you
only after talking with your doctor or health care 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 can make health care decisions for you according to your wishes or according to the Agent’s 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 that he or she knows what is important to you. If your Agent does not know what your wishes would be in a particular situation, your agent will decide based on what he or she thinks would be in your best interests. After your physician has determined that you lack the ability to make health care decisions, if you still object to any decision made by your Agent, your own decision will generally be honored unless a Court determines that you lack capacity to make health care decisions. Your Agent’s decisions will have the same authority as yours would, if you were able, and will be honored over those of any other person, except of any limitation you yourself make, or except for a court Order specifically overriding the Agent.
Is a proxy required for treatment at Lawrence General Hospital?
No. You do not have to choose a health care proxy in order to receive treatment. If you have not completed a Health Care Proxy Form, your family may be asked to make decisions for you based on what they believe you would want. In some cases, a court may be asked to appoint a guardian to make decisions on your behalf.
Whom do I contact with questions?
Your health care providers at the hospital can answer your questions. If you need more information, social workers in the Integrated Care Department can help. Please call 978-683-4000 ext. 2550. Translators are always available for your assistance if necessary.