Massachusetts Healthcare Power of Attorney Requirements
Massachusetts skips the phrase "power of attorney" entirely: state law calls this document a Health Care Proxy, created under its own dedicated chapter, General Laws Chapter 201D, that is entirely separate from the chapter governing Massachusetts's financial power of attorney.
Introduction
Massachusetts skips the phrase "power of attorney" entirely: state law calls this document a Health Care Proxy, created under its own dedicated chapter, General Laws Chapter 201D, that is entirely separate from the chapter governing Massachusetts's financial power of attorney. What the document does is still familiar: it lets you name someone you trust, called your health care agent, to make medical decisions for you if you are ever unable to make them yourself. Unlike a general or financial power of attorney, a Massachusetts Health Care Proxy covers only health care decisions. It says nothing about your money, property, or bills, and by law your health care agent's decisions take priority over anyone acting under a separate durable power of attorney when it comes to medical matters. Signing the document does not hand your agent immediate authority either: your agent can only start deciding for you once your attending physician determines, in writing and entered into your medical record, that you lack the capacity to make or communicate health care decisions. Massachusetts asks for one method of execution: you sign, or direct someone to sign for you, in front of two adult witnesses, and neither witness can be the person you named as your agent. There is no notary option, and the state does not require you to file the document with any registry. You simply keep the signed original and give copies to your physician, your agent, and any alternate agents.
Key Things to Know
- 1
Massachusetts does not call this a power of attorney at all: it is a Health Care Proxy under General Laws Chapter 201D, a law separate from the state's power-of-attorney statute. It lets you (the principal) name a trusted adult (your health care agent) to make health care decisions for you if you become unable to make them yourself.
- 2
Your agent's authority does not start the moment you sign. It begins only after your attending physician determines in writing, entered in your medical record, that you lack the capacity to make or communicate health care decisions (Mass. Gen. Laws ch. 201D, Section 6).
- 3
You sign in front of two adult witnesses. Massachusetts does not offer or require a notary option for a Health Care Proxy, unlike some other states' medical power of attorney forms.
- 4
The only witness restriction under Massachusetts law is that neither witness can be the person you named as your agent. There is no blood relative, marriage, or estate interest bar on witnesses (Section 2).
- 5
An operator, administrator, or employee of a facility where you are a patient or resident, or have applied for admission, cannot be your agent unless that person is related to you by blood, marriage, or adoption (Section 3).
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You can revoke your proxy at any time, orally or in writing, just by telling your agent or a health care provider. It is also automatically revoked if you sign a later proxy or divorce a spouse who is your named agent (Section 7).
- 7
Massachusetts has no central state registry for Health Care Proxies. Keep the signed original and give copies to your physician, your agent, and any alternate agents.
- 8
This is a different document from Massachusetts's Durable Power of Attorney (Mass. Gen. Laws ch. 190B), which covers property and financial decisions, not health care.
- 9
Your health care agent's decisions take priority over anyone acting under a separate durable power of attorney on health care matters (Section 5).
Key decisions before you file
Before you file a Healthcare Power of Attorney in Massachusetts, a few decisions shape the document: which option to choose and what each one means. The Healthcare Power of Attorney guide walks through them.
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Massachusetts Requirements for Healthcare Power of Attorney
The principal designates a primary health care agent, including full name and contact information, who will make health care decisions if the principal becomes unable to make or communicate them (Massachusetts General Laws Chapter 201D, Section 2).
Designation of at least one alternate agent who can serve if the primary agent is unavailable, unwilling, or not competent to act. Must include full name and contact information (Massachusetts General Laws Chapter 201D, Section 2).
The agent's authority begins only after the principal's attending physician determines in writing, according to accepted standards of medical judgment, that the principal lacks the capacity to make or communicate health care decisions, and enters that determination in the principal's medical record (Massachusetts General Laws Chapter 201D, Section 6). Chapter 201D contains no immediate-effect option and no concept of a document being 'durable' or not; that term, and the immediate-versus-springing choice, belongs to Massachusetts's separate Durable Power of Attorney statute (Chapter 190B, Article 5), not to the Health Care Proxy.
The agent has authority to make any and all health care decisions the principal could make, including consenting to, refusing, or withdrawing treatment and life sustaining treatment, subject to any express limitations the principal states in the document (Massachusetts General Laws Chapter 201D, Section 5).
Federal HIPAA regulations govern how the agent can be authorized to access the principal's protected health information once the document is in effect.
The agent's authority under Section 5 explicitly includes decisions about life sustaining treatment, such as ventilation, dialysis, antibiotics, and artificial nutrition and hydration, subject to any limitations the principal states in the document.
Massachusetts General Laws Chapter 201D, Section 13 confirms that nothing in the chapter precludes any medical procedure the attending physician deems necessary for comfort care or pain alleviation, including treatment with sedatives and pain relieving drugs, non artificial oral feeding, suction, and hygienic care.
Under the Massachusetts Uniform Anatomical Gift Act, a health care agent appointed under a Chapter 201D health care proxy may make an anatomical gift of the principal's body or organs for transplantation, therapy, research, or education, unless the proxy or another signed record prohibits the agent from doing so (Massachusetts General Laws Chapter 113A, Section 4(2)).
Section 5's general grant of authority to make any and all health care decisions extends to psychiatric care, including consenting to medication and to conditional voluntary psychiatric hospitalization on the principal's behalf. This authority is affirmed by a Massachusetts Supreme Judicial Court decision (Cohen v. Bolduc) for health care agents applying for conditional voluntary hospitalization under Massachusetts General Laws Chapter 123, Sections 10 and 11. This authority does not extend to involuntary civil commitment, which remains a separate court process under Chapter 123 regardless of the proxy.
Section 5's broad grant of authority to make any and all health care decisions on the principal's behalf extends to decisions about nursing home or long-term care facility placement, subject to any limitations the principal states in the document.
The principal signs, or directs another adult to sign, in the presence of two adult witnesses, who then sign the document themselves; the witnesses must affirm in writing that the principal appeared to be at least eighteen years old, of sound mind, and under no constraint or undue influence (Massachusetts General Laws Chapter 201D, Section 2). The only witness disqualification under Massachusetts law is that the person named as the principal's health care agent cannot also serve as a witness. Unlike in some other states, Massachusetts law does not disqualify witnesses who are related to the principal, who stand to inherit from the principal, or who work for the principal's physician or care facility.
Notarization is not legally required in Massachusetts and is not part of the statutory execution method at all; the document is valid once signed before two qualifying witnesses (Massachusetts General Laws Chapter 201D, Section 2).
The principal may revoke the proxy at any time by notifying the agent or a health care provider, orally or in writing, or by any other act evidencing intent to revoke. The proxy is also automatically revoked by execution of a subsequent proxy, or by divorce or legal separation from a spouse who is the named agent. A physician informed of a revocation must record it in the principal's medical record and notify the agent and known providers (Massachusetts General Laws Chapter 201D, Section 7).
Massachusetts General Laws Chapter 201D, Section 11 states that nothing in the chapter limits the enforceability of a health care proxy or similar instrument validly executed in another state or jurisdiction, though a Massachusetts health care provider is not required to honor it in violation of the chapter's physician or facility conscience-objection provisions (Sections 14 and 15).
Section 5 requires the agent to make health care decisions according to the agent's assessment of the principal's wishes, including the principal's religious and moral beliefs, when those wishes are known; if the principal's wishes are unknown, the agent must act in the principal's best interest. Including a statement of your beliefs helps guide your agent in making decisions that align with your values.
No provision of Chapter 201D requires or references a severability clause for a Health Care Proxy.
Frequently Asked Questions
A Health Care Proxy in Massachusetts is a legal document, created under Massachusetts General Laws Chapter 201D, that lets you name a trusted adult, your health care agent, to make health care decisions for you if you ever become unable to make them yourself. It covers only health care decisions, such as consenting to or refusing treatment, and takes effect only after your attending physician determines in writing that you lack the capacity to decide for yourself.
A Health Care Proxy covers only health care decisions. Massachusetts's Durable Power of Attorney, governed by General Laws Chapter 190B, Article 5, covers property and financial matters instead, and the two are entirely separate instruments under separate chapters of law. The Durable Power of Attorney's effective date is the principal's choice at signing, either immediate or springing on incapacity. The Health Care Proxy has no such choice: your agent's authority always waits for your physician's written incapacity determination. Massachusetts law also gives your Health Care Proxy agent's decisions priority over anyone acting under a Durable Power of Attorney when it comes to health care matters.
No. Massachusetts law requires two adult witnesses to sign your Health Care Proxy and does not offer or require notarization as part of the execution process (Massachusetts General Laws Chapter 201D, Section 2).
Massachusetts law disqualifies only one type of witness: the person you have named as your health care agent cannot also sign as a witness. Unlike some states, Massachusetts does not bar witnesses who are related to you by blood or marriage, who stand to inherit from you, or who work for your physician or care facility (Section 2).
Generally no. An operator, administrator, or employee of a facility where you are currently a patient or resident, or where you have applied for admission, cannot serve as your agent unless that person is related to you by blood, marriage, or adoption (Massachusetts General Laws Chapter 201D, Section 3).
No. Massachusetts does not operate a central advance directive or Health Care Proxy registry. You keep the signed original yourself and give copies to your physician, your agent, and any alternate agents.
You can revoke it at any time by telling your agent or a health care provider, orally or in writing, or by any other act showing your intent to revoke. It is also automatically revoked if you sign a later Health Care Proxy, or if you divorce or legally separate from a spouse who is your named agent (Massachusetts General Laws Chapter 201D, Section 7).
Massachusetts does not categorically bar your treating physician from serving as your agent, unlike some states. The one restriction is that a physician who serves as your agent cannot also be the physician who determines that you lack capacity to make health care decisions; a different physician must make that determination instead (Massachusetts General Laws Chapter 201D, Section 6).