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Advance medical directives: Living wills and health care proxies

Introduction

Few people like to think about what will happen what will happen if they get seriously ill, what treatment options they will be faced with and what decisions they will have to make. So many persons simply postpone thinking about this situation, reasoning "If and when I get sick, I will make the decisions then." However, what happens if they get sick and they are unable to communicate, maybe because they are in a coma or because they are in extreme pain or discomfort?

While it is often thought that this situation arises most often in the case of old age, unexpected situations may happen at any time during a person's lifespan, at any age, for any number of reasons, such as an illness like cancer, or an automobile or other accident. That is why it is so important to have advance directives, which are written instructions that deal with medical care preferences. The two most common advance directives are living wills and health care proxies.

Living wills

A "living will" can be defined as a document which describes the types of medical treatment that a person wants if he or she becomes permanently unconscious or terminally ill. It allows a person to make medical decisions up front while he or she is mentally and physically competent.

Massachusetts, along with a few other states, does not recognize living wills as legally binding. If a person writes a living will, doctors are not legally obligated to follow the directions of a living will. A living will, however, can provide help or assistance to the courts and health-care providers to make medical care decisions.

A living will should be specific about life-prolonging measures, for example, artificial nutrition and "Do Not Resuscitate" orders, that a person accepts or rejects. Because there is no law or statute that authorizes living wills in this state, a standard format for this document does not exist, although sample forms can be found online.

An addition or alternative to living wills are health care proxies, which are legally binding.

Health care proxies

A health care proxy designates a person who may make medical decisions for another person when and if the other person is mentally or physically unable to do so. The Massachusetts Health Care Proxy Law permits a person to appoint a proxy (who the statute refers to as an "agent") using the health care proxy form.

The proxy becomes effective when a person's doctor makes a determination that the person is unable to communicate decisions concerning health care. Health care facilities and providers must follow the agent's decisions.

A person may appoint almost anyone as an agent. A person is also allowed to appoint an alternate agent, for when the agent is unable or unavailable to make health care decisions.

Once the appointment is made, it is important that the person discusses treatment preferences with the agent. A person is allowed to specify on the form certain treatments that he or she wants or does not want.

Conclusion

While living wills are not recognized legally in Massachusetts, and while you do not need your lawyer to file the health care proxy form to make it binding legally, it is always a good idea to consult with a lawyer before making any decision that has legal or life changing consequences. The lawyer will listen to your concerns and advise you of all of the available alternatives.

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