MA Health Care Proxy

A Health Care Proxy (sometimes called a health care “agent”) is someone who can be your voice if you are ever unable to make or express health care decisions yourself. It’s up to you to pick your Health Care Proxy. This person can make sure your care providers know what matters to you if you are ever too sick to speak for yourself.

It is 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 Health Care Proxy form. Many serious health problems come up unexpectedly. Think of the Proxy as a form of insurance: you hope you never need it, but if you do, it’s important that you’re prepared.

When health care decisions are made, the patient's voice and opinion are of utmost importance. In fact, expressing your personal health care wishes and taking part in decisions related to your health care are part of your basic rights as a patient. However, situations - such as accidents or severe illnesses - sometimes arise that can prevent you from participating in decisions about your care. Therefore, while you are able, it is important for you to decide what is important to you about your care in case you ever become too sick to speak for yourself. It is equally important that you communicate your wishes to your family and friends and your health care providers.

Beth Israel Deaconess Medical Center encourages all patients to prepare a Health Care Proxy document. This document will identify the person you have chosen to express your wishes regarding your health care in the event that you become unable to speak for yourself.

Some of the common questions about the Health Care Proxy appear below. Please read through this information and discuss it with your family and those who are closest to you, as well as with your physician, nurse, social worker, or chaplain. Please ask one of our staff if there is anything you do not understand.

Yes. A Health Care Proxy is not the same as a living will or other forms people often use to document their wishes. While living wills and other planning forms are useful tools, they cannot possibly cover every situation that may arise or every decision that may need to be made. That is why having a Proxy is so important. The Proxy can be your voice and can speak for you no matter what health care decision needs to be made. Additionally, in Massachusetts, if you cannot make or express your own health care decisions, a completed Health Care Proxy form is the only legally binding document related to your health care. For more information, see “Important Terms to Know.”

No. All adults- people who are perfectly healthy as well as people who are sick - are encouraged to prepare a Health Care Proxy. Many serious health problems arise unexpectedly. That is why it is important to have a Health Care Proxy ready at all times.

The Massachusetts Health Care Proxy form can be downloaded and printed out here. If you need another copy, your physician, nurse, social worker, or someone from pastoral care at the medical center can get you one. The form becomes valid after it is signed by you and witnessed by two adults. The person you are naming as your agent cannot be one of the witnesses.

Do I need a lawyer or a notary?

No. The Massachusetts Health Care Proxy Form is part of this packet and 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.

Do I need witnesses?

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 from your personal life. But if needed, hospital staff may serve as wit­nesses. (If they do, they should give their work address on the form.) A copy of the form is just as valid as the original.

Your Proxy makes decisions for you only after your doctor has said that you are not 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 as long as you remain unable to communicate your own wishes. If your doctor says that your ability to speak for yourself has returned, your Proxy no longer speaks for you.

If you go to another hospital in Massachusetts and you have a copy of your Proxy form, you do not 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.

Your Health Care Proxy should be someone who can understand and respect your values and wishes about health care. It should also be someone who will be willing and able to communicate your values and wishes to your health care providers, even if this is difficult to do. It is often a spouse or a close family member, but it does not 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.
• If you are currently a patient at a health care 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 be providing care for you and serving as your Proxy at the same time.

In Massachusetts, you may name one “primary” Proxy and also an “alternate” Proxy. The alternate person would only step in as your Proxy 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 very helpful to your Proxy if he or she needs to make difficult choices about your care. Talking to your Proxy about who should be part of this process is important. (See “How will my proxy know what I want?”) Still, in the end your health care team will look to your Proxy to speak for you.

If a family member does not 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 challenge your Proxy’s decisions.

• Give your Health Care Proxy and Alternate a copy of this form. You may also want to give a copy to your lawyer or close family members or friends.
• Give a copy of this form to your primary care provider and to any specialists you see often. Ask them to make sure that your Proxy information, or a copy of this form, is in your medical record.
• Keep a copy for yourself and try to bring it with you if you have to go to the hospital.
• Talk to your Health Care Proxy about what matters most to you. Think about what you would or would not want if you were very sick, or if you were at the end of your life. See “How will my Proxy know what I want?& ; below to plan a conversation with your Proxy and other loved ones.

• Talk with your health care providers about what is most important to you. Talk about the care you would want to receive if you were very sick. If members of your health care team know about your wishes, they may be very helpful to your Proxy if difficult decisions ever need to be made about your care.

It’s important to plan a conversation with your Health Care Proxy. Imagine that you’re seriously injured or ill and your Proxy is called. Would he/she know what you’d want? Help make sure you’re both ready. Set aside a time and place to have a conversation with your Proxy and perhaps other people close to you. For more tips, visit BIDMC's Conversation Ready pages, see the Conversation Starter Kit, and use the one-page Conversation Planning Worksheet.

You do not need a Health Care Proxy to receive care at BIDMC . But if you do not have one, your health care providers will automatically turn to your family for guidance regarding your wishes. If you have not 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 do not have a Health Care Proxy, decisions about your care will need to be addressed in court in certain situations. 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.

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

• You fill out a new form at a later date
• You legally separate from or divorce your spouse, and your spouse was named as your agent. (If you wish to use your ex as your Proxy, you may do so as long as the form naming this person as your Proxy was completed after the date of your separation or divorce.)
• You tell your agent, doctor or other health care provider, verbally or in writing, that you have changed your mind about your Proxy

• An advance directive refers to any instructions about your health care that you might prepare "in advance." There are many different types. A Health Care Proxy is one type. A living will is another.
• A Health Care Proxy is someone you name to speak for you about your health care if you become unable to make or express decisions yourself. Your Health Care Proxy speaks for you only on health care matters.
• A living will is a type of advance directive in which you say what you would or would not want in certain circumstances. It can be helpful as evidence of your preferences, but it cannot possibly cover every situation or question that might arise about your care. That is why having a Health Care Proxy is important.
• A durable power of attorney is someone you name to act on your behalf regarding financial, legal, and other matters. (Note: outside of Massachusetts, the Health Care Proxy is sometimes called the "Durable Power of Attorney for Health Care." This is not the same as a Durable Power of Attorney.)
• A MOLST (Medical Orders for Life Sustaining Treatment) form is a voluntary form for patients with serious advanced illness. This form can be completed only after a conversation with a health care provider to discuss the patient's end-of-life wishes, so that the form ensures the patient receives all of the treatments that make sense for him or her and none of the ones that don't. Examples of life-sustaining treatment are CPR and breathing machines. To learn more, visit www.molst-ma.org or speak with your health care team.

If you have any questions please talk with your physician, nurse, social worker, or chaplain. If you need additional information, call the department of social work (617-667-3421), pastoral care (617-667-3030), or the ethics support service (617-667-3095).