![]() Tell the person you choose that he or she will be your health care agent. ![]() Before appointing someone as your health care agent, discuss it with him or her to make sure that he or she is willing to act as your agent.Ask staff at the facility to explain those restrictions. Also, if you are a patient or resident of a hospital, nursing home or mental hygiene facility, there are special restrictions about naming someone who works for that facility as your agent. If you select a doctor as your agent, he or she will have to choose between acting as your agent or as your attending doctor because a doctor cannot do both at the same time. You may choose any adult (18 years of age or older), including a family member or close friend, to be your agent.You do not need a lawyer to fill out this form.Your agent must follow your instructions when making decisions for you. The instructions may be used to limit the decision-making power of the agent. You may write on this form examples of the types of treatments that you would not desire and/or those treatments that you want to make sure you receive.Your agent will start making decisions for you when your doctor determines that you are not able to make health care decisions for yourself.Unless your agent reasonably knows your wishes about artificial nutrition and hydration (nourishment and water provided by a feeding tube or intravenous line), he or she will not be allowed to refuse or consent to those measures for you."Health care" means any treatment, service or procedure to diagnose or treat your physical or mental condition. Health care proxy forms give the person you choose as your agent the authority to make all health care decisions for you, including the decision to remove or provide life-sustaining treatment, unless you say otherwise in this form.Both are recommended as an important part of every estate plan. There is no way to predict when an accident might happen or when such a document will be needed. These documents are needed not just for the elderly or infirm. Again, this is extremely important if you become incompetent. The health care agent can even make decisions concerning the use or terminating the use of life support systems. ![]() This episode features Emerson's Lee Holbrook, social worker supervisor, and Mary Crow, director of professional and community education at Care Dimensions.A Massachusetts health care proxy is a document by which 1 individual (the principal) appoints another (the health care agent) to make health care decisions for him or her should he or she be unable to make or communicate such decisions for himself or herself. Learn how to get started developing these documents for yourself or family members. We explain the differences between living wills, healthcare proxies, powers of attorney, and DNRs. ➤ Advanced Directives: A Little Planning Brings a Lot of Peace of Mind Listen to the Podcast Please contact the care management department at (978) 287 3170 to schedule an appointment. If you have been a patient at Emerson, you may also send a copy to the address below for inclusion in your Emerson Health medical record.Įmerson Health offers free appointments with our social work department to assist in completing the health care proxy. Keep the original for your files and make a copy for your primary care provider. The form must be signed by two witnesses (the chosen proxy cannot be a witness) or notarized. You can download the form from the Honoring Choices website. To find out more information about completing a health care proxy, please visit To complete your health care proxy, first discuss this decision with your chosen proxy. You have the right to appoint someone by filling out a form called a health care proxy.Įmerson Health has partnered with Honoring Choices, a nonprofit organization that supports adults in determining their health care choices. If you don’t plan ahead, family members or other people close to you may not be able to make decisions for you that follow your wishes.Īppointing someone you can trust to decide about treatment if you become unable to decide for yourself is the best way to protect your treatment wishes and interests. ![]() You may wish to plan in advance to make sure that your wishes will be followed if you become unable to decide for yourself. Sometimes due to illness or injury, people are unable to talk to a doctor and decide about treatment themselves. This means that you have the right to request or consent to treatment, to refuse treatment before it has started and to have treatment stopped once it has begun. Adults in Massachusetts have the right to accept or refuse medical treatment, including life-sustaining treatment. ![]()
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