Back to top

The 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:

To plan for the future possibility of accidents or illness, all adults (aged 18 and older) should use a health care proxy form to appoint their health care agent.  

In Massachusetts, if a person becomes incapable of making medical decisions (e.g., due to unconsciousness, dementia or other mental limitations), it is their "health care agent" who is authorized to make medical decisions for them.  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
  • Print a Health Care Proxy formAdobe PDF  (See a Health Care Proxy form in Spanish)
  • Complete and sign the form
  • Ask two other people to sign the form as witnesses
  • Put the form where it is easy to find
  • Give a copy of your health care proxy form to your health care agent
  • Remember to talk about your medical care preferences with your health care agent