Plan Ahead to Ensure Medical Wishes are Honored

Elderly man being treated for a heart attack


Julie rushed to the hospital after learning her father, Paul, had been admitted after falling and suffering a traumatic brain injury. When she arrived, Paul was lying unconscious in the ICU on a ventilator and numerous IVs. He awakened for a moment and reached out to her. They grabbed each other’s hands and then he quickly lapsed into unconsciousness. This lasted for over a week as his condition deteriorated. Julie and her siblings were at a loss what to do, because Paul had never made his wishes known to his family and hadn’t drafted any formal legal instructions. The doctors couldn’t say for sure whether or not Paul was in pain and said his chances for recovery were slim. Julie and her family agonized for over a week, before deciding to take Paul off the ventilator and feeding tube. He passed away three hours later. Julie still agonizes about her decision, not knowing if it is what Paul would have wanted.

April 16-22 is National Healthcare Decisions Week. It is meant to draw attention to the importance of planning ahead for your end-of-life care. There are several different types of documents used in healthcare planning. In Massachusetts, there are two basic healthcare documents that everyone should have.

Health Care Proxy

A health care proxy is a legal document that names a person you choose to make health care decisions for you if you are unable to do so. Some states refer to this as a Power of Attorney for Health Care, which is the same thing. The person you name is called your agent and this individual has the ability to make medical decisions for you in case you are unconscious, in a coma, or lack the mental ability to make these decisions on your own. The Health Care Proxy grants your agent the authority to make any health care decision on our behalf, up to and including the ability to consent to or refuse any medical treatment, including treatment that could keep you alive. Because their power to act on your behalf is so broad, it is imperative to choose someone you can trust to act in your best interests and to communicate to them (preferably in writing) about what conditions you would or would not want to receive life-saving treatment. In order to have your health care proxy be legally binding, you must sign the document (or direct another to sign it) in the presence of two witnesses, who must also sign the document.

Choosing an Agent

If you wish to name an individual as your health care agent, ask the person if he or she is willing to take on that responsibility. If the person agrees, then you should sit down with him or her and have a frank, detailed conversation about your feelings and values concerning health care and the kinds of treatment you would or would not want. Along with this conversation, be sure to give your agent copies of your Advance Directive or Personal Wishes Statement. Share those documents with others as well, so everyone is aware of your wishes. This can help alleviate questions and anxiety during a time of high stress.

Personal Directive/Living Will

Massachusetts is one of only three states that does not recognize living wills. But you should still create one. Federal law gives you the right to direct your medical care and creating a living will, if nothing else, provides important guidance to your agent, other loved ones and health care providers about your wishes.

You can learn more about choosing an agent, health care proxies and personal directives here.

In addition to these two forms, you may want to consider a Medical Orders for Life-Sustaining Treatment (MOLST) form. This differs from a Personal Directive in one important way – a MOLST form is effective immediately and is signed by both the patient and health care provider – a Personal Directive only becomes effective when you are unable to speak for yourself and your physician or clinician has no say in the matter. A MOLST form will usually include things like whether or not a person should be resuscitated, ventilated, or transferred to a hospital. For the most part, MOLST has taken the place of the Comfort Care/Do Not Resuscitate (CC/DNR) form, although that form still exists and is legally binding. If you have signed a MOLST form, there is no need for a CC/DNR form.

To learn more, please visit the National Healthcare Decisions Day website.