Healthcare Proxy Massachusetts: How to Appoint a Medical Decision-Maker

Your parent just got discharged from the hospital, and the social worker asked who holds their healthcare proxy. Nobody does. Now you're scrambling to figure out what that even means, who can serve, and whether you need a lawyer to set one up.

Massachusetts handles medical decision-making authority differently than most states, and the rules matter when a parent's health is declining.

What a Healthcare Proxy Does in Massachusetts

A healthcare proxy, authorized under M.G.L. c. 201D, lets your parent appoint someone — called a "health care agent" — to make medical decisions on their behalf. The document stays dormant until an attending physician determines in writing that your parent can no longer make or communicate healthcare decisions.

Once activated, the agent can consent to or refuse treatment, choose providers, and access medical records. The agent cannot override your parent's previously expressed wishes if those wishes are documented.

Two important distinctions from other states:

• Massachusetts does not recognize living wills. There is no standalone legal document where your parent can list end-of-life wishes and have them be legally binding. Instead, specific wishes about life-sustaining treatment must be written directly into the healthcare proxy itself or recorded in a separate "Personal Wishes" document.
• The proxy does not require notarization. Your parent signs it in the presence of two adult witnesses, neither of whom can be the named agent.

Healthcare Proxy vs. Durable Power of Attorney

These two documents serve completely different functions, and your parent likely needs both:

Healthcare Proxy covers medical decisions only — treatment consent, provider selection, end-of-life choices. It activates when a physician certifies incapacity.

Durable Power of Attorney (DPOA) covers financial and legal decisions — managing bank accounts, paying bills, filing MassHealth applications, handling real estate transactions. Under the Massachusetts Uniform Power of Attorney Act, a DPOA is durable by default, meaning it remains effective even after incapacity. The principal's signature must be notarized.

If your parent has a DPOA but no healthcare proxy, you might be able to manage their finances but have zero authority to make medical decisions. A hospital can legally refuse to take direction from a financial power of attorney on treatment questions.

Healthcare Proxy vs. MOLST

A Medical Orders for Life-Sustaining Treatment (MOLST) is not a planning document — it's an active medical order signed by both the patient (or their healthcare agent) and a licensed clinician. It directs paramedics and emergency responders on CPR, intubation, mechanical ventilation, and tube feeding.

First responders cannot follow a healthcare proxy in an emergency. They can follow a MOLST or a Department of Public Health Comfort Care/DNR order.

If your parent has strong preferences about resuscitation or life support, the healthcare proxy appoints the decision-maker, and the MOLST gives the actual medical order that first responders will honor.

How to Complete a Healthcare Proxy

The process is straightforward and does not require an attorney:

1. Download the form from the Massachusetts Executive Office of Health and Human Services. It's a single page.
2. Choose an agent. Any competent adult can serve except your parent's healthcare provider or an employee of their healthcare facility (unless that person is also a family member).
3. Name an alternate agent. If the primary agent is unavailable or unwilling, the alternate steps in automatically.
4. Include specific wishes. Write any treatment preferences, religious considerations, or end-of-life instructions directly into the proxy. Massachusetts won't enforce a separate living will, so this is the place.
5. Sign with two witnesses. Both witnesses must be adults. Neither can be the named agent. There is no notarization requirement, though notarizing adds an extra layer of protection against future challenges.
6. Distribute copies to the agent, alternate agent, your parent's primary care physician, and any hospital where your parent receives regular care.

When You Need Court-Ordered Guardianship Instead

If your parent has already lost the capacity to sign legal documents and never executed a healthcare proxy, the only path to medical decision-making authority is petitioning the Probate and Family Court for guardianship under M.G.L. c. 190B, Article V.

This requires filing a Petition for Appointment of Guardian (MPC 120), a Medical Certificate (MPC 400) from a physician completed within 30 days of filing, and a Bond (MPC 801). The court typically appoints an independent Guardian Ad Litem to evaluate the situation. The process takes weeks and costs thousands in legal fees.

A healthcare proxy executed while your parent still has capacity avoids all of this.

What to Do Right Now

If your parent doesn't have a healthcare proxy, getting one signed is the single most important legal step you can take this week. It costs nothing, requires no attorney, and prevents a court proceeding that could cost $3,000 to $8,000 in legal fees.

The Massachusetts Home Care Navigation Guide includes a complete legal authority checklist covering healthcare proxies, durable powers of attorney, and the specific court forms needed if guardianship becomes necessary — organized in the sequence you'll actually need them.

See more Massachusetts guides →