Massachusetts Living Will Requirements

Massachusetts recognizes the Health Care Proxy, not a living will, as its only legally binding advance directive. This designates a trusted adult to make health care decisions on your behalf if you cannot. It must be signed before two adult witnesses; the only witness disqualification in the statute is the person you have named as your agent.

You may designate an alternate agent to serve if your primary health care agent is unavailable, unwilling, or unable to act, or becomes disqualified under the chapter's other requirements. This provides continuity in decision making authority.

Your agent's authority begins only after your attending physician determines, using accepted medical standards and in writing, that you lack the capacity to make or communicate health care decisions. This is the trigger for your agent's authority under the Health Care Proxy. Massachusetts has no separate trigger condition list for a living will, because it has no living will statute.

Massachusetts has no independent living will statute, so a statement of treatment wishes is not binding by itself. It carries legal weight two ways: written into your Health Care Proxy as a Section 4 limitation on your agent's authority, or as evidence a court may honor under the substituted judgment doctrine established in Superintendent of Belchertown State School v. Saikewicz (1977) and Brophy v. New England Sinai Hospital, Inc. (1986), which specifically applied the doctrine to artificial nutrition and hydration.

Chapter 201D, Section 13 lets a physician provide comfort care or pain alleviation, including sedatives, pain killing drugs, non-artificial oral feeding, suction, and hygienic care, even if these measures could hasten death. The federal Patient Self-Determination Act separately requires facilities to inform patients of their advance directive rights but does not itself authorize specific pain management measures.

Massachusetts's Uniform Anatomical Gift Act, Chapter 113A, lets you authorize organ and tissue donation, including through a statement or symbol on your driver's license or a donor registry entry, separate from your Health Care Proxy or statement of wishes.

You may include your religious or cultural beliefs as part of the wishes your health care agent must consider under Chapter 201D, Section 5's requirement that an agent act in accordance with your known wishes, including your religious and moral beliefs.

Federal HIPAA regulations let you authorize your health care agent and any alternates to receive your protected health information so they can make informed decisions once your Health Care Proxy is in effect.

You may revoke your Health Care Proxy, and any statement of wishes attached to it, at any time by notifying your agent or a health care provider orally or in writing, or by any other act communicating your intent to revoke. Once informed, physicians must record the revocation and notify relevant parties.

Massachusetts law contains no pregnancy exclusion clause. Your Health Care Proxy and any attached statement of wishes keep full effect regardless of pregnancy status.

A health care proxy or similar instrument validly executed in another state or jurisdiction under that jurisdiction's law is enforceable in Massachusetts, so long as honoring it would not require violating the physician and facility refusal provisions of Sections 14 and 15.

You may nominate your health care agent as your guardian of the person in the event a separate court guardianship proceeding becomes necessary, to help keep decision making consistent. Guardianship itself is a separate court process from the Health Care Proxy.

Massachusetts law does not impose a general requirement that you list who must be notified when your Health Care Proxy becomes effective. The only related statutory duty is narrower: under Section 7, once a physician or agent learns of a revocation, the physician must record it and notify relevant parties. Naming people to notify in advance is good practice, not a Chapter 201D mandate.

Two adult witnesses must attest in writing that you appeared to be at least eighteen, of sound mind, and under no constraint or undue influence when you signed. The only witness disqualification stated in the statute is your named health care agent. Massachusetts does not disqualify witnesses for being related to you by blood or marriage, or for being named in your will.

Massachusetts has no living will statute of any kind, combined or separate. The Commonwealth's own legal guidance states that a living will is not legally binding on your doctors by itself. Its real legal weight comes from two Supreme Judicial Court cases applying the substituted judgment doctrine: Superintendent of Belchertown State School v. Saikewicz (1977) established that courts will honor the treatment choice an incapacitated person would have made, and Brophy v. New England Sinai Hospital, Inc. (1986) applied that doctrine specifically to withdrawing artificial nutrition and hydration based on a patient's own prior statements.