Medical Orders for Life-Sustaining Treatment

The Massachusetts Health Care Proxy Form

All adults (age 18 and older) should use a health care proxy form to appoint their health care agent.  

In Massachusetts, if a person is not capable of making medical decisions (e.g. because they are unconscious, or due to dementia or other mental limitations), it is their "health care agent" who is authorized to make medical decisions on their behalf.  It cannot be assumed that a family member or friend will be authorized to make medical decisions in every situation or setting. 

How to appoint your health care agent:

1) Choose someone you trust the most to:

  • Act on your behalf in the future if you become unable to make decisions yourself
  • Listen to and understand your values, goals and wishes about medical care
  • Agree to make the decisions you would want - not necessarily what they want

2) Print the Health Care Proxy formAdobe PDF

3) Complete and sign the form

4) Ask two other people to sign your form as witnesses

5) Put the form where it is easy to find

You should discuss your treatment wishes with your health care agent and other loved ones; and provide a copy of your health care proxy form (and the MOLST form if you have one) to your health care agent.

Anyone who completes a MOLST form should also have a health care agent.

Find out how MOLST is different from a health care proxy form.