Massachusetts Health Care Proxy: information, instructions, and form.

NOTICE: The following form is protected by federal copyright law and may be photocopied or reproduced only by the end user for his or her personal use. Health care organizations, institutions, professionals, and others can purchase the form in quantity from Massachusetts Health Decisions, the non-profit publisher of the form and educational materials related to the Massachusetts Health Care Proxy. The form is available in English and nine other languages. A complete information packet including two copies of the form, a basic brochure, and a 16-page "User's Guide" in question-and-answer format is available for $6 postpaid. The Health Care Proxy is a simple legal document that allows you to name someone you know and trust to make health care decisions for you if, for any reason and at any time, you become unable to make or communicate those decisions. It is an important document, however, because it concerns not only the choices you make about your health care, but also the relationships you have with your physician, family, and others who may be involved with your care. Read this and follow the instructions to ensure that your wishes are honored. Under the Health Care Proxy Law (Massachusetts General Laws, Chapter 201D), any competent adult 18 years of age or over may use this form to appoint a Health Care Agent. You (known as the "Principal") can appoint any adult EXCEPT the administrator, operator, or employee of a health care facility such as a hospital or nursing home where you are a patient or resident UNLESS that person is also related to you by blood, marriage, or adoption. Your Agent will make decisions about your health care only when you are, for some reason, unable to do that yourself. This means that your Agent can act for you if you are temporarily unconscious, in a coma, or have some other condition in which you cannot make or communicate health care decisions. Your Agent cannot act for you until your doctor determines, in writing, that you lack the ability to make health care decisions. Your doctor will tell you of this if there is any sign that you would understand it. Acting with your authority, your Agent can make any health care decision that you could, if you were able. If you give your Agent full authority to act for you, he or she can consent to or refuse any medical treatment, …