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Massachusetts Health Care Proxy Form

The purpose and use of MOLST is very different from the use of a Health Care Proxy.


Important Information about Health Care Proxy forms in Massachusetts:

It cannot be assumed that a spouse or other family member will be authorized to make medical decisions on their loved one's behalf in every situation or setting.

To plan for future medical care, all adults ages 18 and older should name (appoint) their health care agent by filling out and signing a legal form called a health care proxy form (See a health care proxy form in Spanish).

In Massachusetts, if a person has lost the ability to make medical decisions (e.g. because of unconsciousness, coma, dementia or other mental limitations), it is their "health care agent" who is legally authorized to make medical decisions on their behalf.  

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 a Health Care Proxy formAdobe PDF   (See a health care proxy form in Spanish).
  3. Complete and sign the form
  4. Ask two other people to sign the form as witnesses
  5. Put the form where it is easy to find
  6. Give a copy of your health care proxy form to your health care agent
  7. Remember to talk about your medical care preferences with your health care agent

For a person with a current serious advancing illness, in addition to signing a health care proxy, using a medical form called "MOLST" may be an option. MOLST is very different from a health care proxy form, because 1) it is not for everyone, and 2) it is a medical order form (like a prescription) that must be filled out by a clinician in the context of discussions with the patient.