Advanced Directives

We often get questions from our Assisted Living residents and their families concerning Advance Directives and DNRs. These are documents which give individuals the opportunity to make legally binding decisions about their future medical care. Most seniors feel comforted knowing that decisions will be made according to their wishes.

The information below pertains to the state of Massachusetts. You should check to make sure that your state also legally recognizes these documents.

The Health Care Proxy allows you to appoint an Agent to make health care decisions for you if you are incapable of doing so yourself. Most people select someone who is knowledgeable about their wishes and religious beliefs, and in whom they have trust and confidence, such as a family member or friend. A Health Care Proxy becomes effective when a determination is made by your attending physician that you lack the capacity to make or to communicate health care decisions and your Agent consents to start making those decisions. If your doctor determines that you have regained the capacity to make or to communicate your own decisions, then your Agent’s authority will end and your consent will be required for treatment. A Health Care Proxy only affects medical care. It is not a “Power of Attorney” which deals only with personal and financial matters. A Health Care Proxy is legally recognized in Massachusetts. Under the Health Care Proxy Law, M.G.L. c. 201D, any competent adult who is 18 years of age or over may appoint a Health Care Agent.

In the majority of states, a Living Will is a legally enforceable document which ensures that a doctor who abides by a patient's wishes will not incur any liability. A Living Will only applies if you are in a terminal condition and you are permanently unconscious. Unless you write in other instructions, the Living Will only tells your doctor that you do NOT want life-sustaining treatments, such as being placed on a mechanical respirator. A Living Will deals with medical issues while you are still living. It is completely different and separate from your will or living trust - these are financial documents. Some people who do not have a family member or close friend whom they trust and who knows their preferences concerning medical treatment will choose to fill out a Living Will. Other people choose to have both a Health Care Proxy and a Living Will. All but three states - Massachusetts, Michigan and New York - have passed living will laws to protect a patient's right to refuse medical treatment. Even in states without Living Will laws this document is useful to a judge trying to decide what an unconscious patient would want.

A Do Not Resuscitate order (DNR) covers only two types of situations. It states that if you suffer cardiac arrest (your heart stops beating) or respiratory arrest (you stop breathing), your health care providers are not to try to revive you by any means. A DNR order is a document prepared by your doctor at your direction and placed in your medical records. You can have a DNR in addition to a Living Will or a Health Care Proxy.

Advance Directives Forms for the state of Massachusetts: Health Care Proxy and Living Will forms can be downloaded for free from the internet. These sites provide detailed information and forms: www.healthcareproxy.org (Mass. Medical Society) and www.mass.gov (Mass. state government site) and www.lawlib.state.ma.us/formsf-l.html (Mass. Trial Court Law Libraries site).