How to Create a Health Care Proxy in Massachusetts

To create a health care proxy in Massachusetts, fill out a written form naming the person you want to make medical decisions for you, and sign it in front of two adult witnesses who watch you sign and confirm in writing that you appeared to be at least 18, of sound mind, and free from undue influence. The person you name as your agent cannot serve as one of the witnesses. No notary is required, no lawyer is required, and the state provides a free form that satisfies every legal requirement.¹

The Steps to Sign a Valid Proxy

Massachusetts law, found in Chapter 201D of the General Laws, sets a short list of formalities. Any competent adult can execute a proxy. You sign a written document (or direct someone to sign it for you) in the presence of two adult witnesses, and each witness affirms in writing that you appeared to be 18 or older, of sound mind, and acting free from constraint or undue influence. The person you appoint as your agent cannot be one of the two witnesses.¹

There is no notarization step. You can complete the whole process at a kitchen table with two willing adults.

For the form itself, the simplest option is the free downloadable proxy on mass.gov, which meets every statutory requirement.² Hospitals, physician offices, and elder law attorneys also distribute forms. If you hire an attorney to draft one as part of a broader estate plan, expect to pay a few hundred dollars, though the document is straightforward enough that most people handle it themselves.

The law presumes every adult is competent and every proxy is properly executed unless a court rules otherwise. Hospitals and doctors should accept your proxy at face value rather than demanding proof that you were competent when you signed.¹

Choosing Your Agent

The person you name is the whole point of the document. You want someone who will follow your wishes even when relatives disagree, who can stay level-headed during a medical crisis, and who is realistically available to get to a hospital. The National Institute on Aging suggests asking yourself whether you trust this person with your life, whether they can handle conflicting opinions from family and clinicians, and whether they live close enough to be present when decisions need to be made.³

Family members can serve, and there is no statutory rule against it. The real question is whether the person’s emotional attachment might prevent them from honoring a difficult decision you have made in advance. Talk to your agent before you sign. Cover your values, how you feel about life-sustaining treatment, pain management, and what quality of life means to you. A proxy form without that conversation behind it is a piece of paper, not a plan.

Name an Alternate

The same form lets you name an alternate agent, who steps in when your primary agent is unavailable, unwilling, or unable to serve and is not expected to become available in time given your medical circumstances.¹ Naming one is optional, but skipping it is a common and easily avoidable mistake. If your sole agent is traveling, hospitalized themselves, or simply unreachable, the proxy becomes useless at the exact moment you need it.

When the Proxy Actually Takes Effect

The proxy sits dormant until a physician determines you lack the capacity to make health care decisions yourself. The form must indicate that the agent’s authority becomes effective only upon that determination.⁴

Signing does not hand your agent any immediate power. You keep full control of your own care, you can override your agent’s preferences, and you can revoke the proxy entirely at any time. The agent’s role activates only when you physically or mentally cannot participate in your own care.

What Your Agent Can and Cannot Do

Once activated, the scope is broad. Your agent can make any health care decision you could make yourself, including decisions about life-sustaining treatment, subject only to any explicit limitations you wrote into the document.⁵

The statute tells the agent how to decide. First, act based on your wishes, including your religious and moral beliefs. If your wishes on a particular question are unknown, act in your best interests. That is why the conversation matters: the more clearly you have communicated your values, the more guidance the agent has when a question arises that you never specifically addressed.⁵

Your agent is also entitled to receive the medical information needed to make informed decisions, including confidential records you would be entitled to see yourself.⁵ Under HIPAA, the agent is treated as your personal representative for purposes of accessing your protected health information.⁶

A proxy covers health care only. It does not authorize your agent to manage your finances, sign contracts, or handle legal matters; those require a separate durable power of attorney. It also cannot be used to authorize commitment to a mental health facility, which requires a separate court process. And if you wrote specific instructions into the proxy, your agent must follow them, not override them. Agents making decisions in good faith are shielded from liability, but an agent who ignores your clearly expressed wishes, acts for personal gain, or operates outside the scope of health care authority loses that protection, and family members, providers, or the principal can petition a court to revoke the appointment.⁷

Where a Proxy Fits Alongside Other Directives

A proxy names a decision-maker. It is not a living will (a written statement of your treatment preferences), and it is not a physician’s order like a DNR or a Massachusetts MOLST form, both of which are medical orders signed by a clinician after a conversation about your condition and preferences.⁸ Every adult should have a proxy regardless of health status. The other documents work alongside it.

Distribute Copies Where They Will Be Found

A proxy no one can locate during a crisis is as useful as one that was never signed. After signing, give copies to your agent, your alternate, your primary care physician, and any specialists who treat you regularly. If you are admitted to a hospital or move into a care facility, ask that a copy be placed in your medical record. A wallet card noting that you have a proxy, naming your agent, and indicating where a copy can be found is worth keeping. Some people also store a digital copy on their phone or in a cloud folder the agent can reach.

Massachusetts does not operate a statewide electronic registry for advance directives, so distribution is entirely on you. Revisit your list any time you sign a new proxy, change physicians, or move.

Changing or Revoking Your Proxy

You can revoke your proxy at any time while you are competent. The law recognizes several methods: tell your agent or health care provider orally or in writing, or take any other action that shows a clear intent to revoke. Executing a new proxy automatically revokes the old one.⁹

One provision catches people off guard. If you named your spouse as your agent and you later divorce or legally separate, the proxy is automatically revoked by operation of law. If you go through a divorce, signing a new proxy with a different agent belongs near the top of your post-divorce checklist.⁹

Massachusetts does not allow partial amendments. To change your agent, update instructions, or add an alternate, you sign an entirely new document with the same formalities: your signature, two adult witnesses, and the required witness affirmation. Once the new proxy is signed, make sure every person and institution holding the old one receives the replacement.

Why This Matters More Than the Paperwork Suggests

Without a proxy, no one has automatic legal authority to make medical decisions for you simply because they are your spouse, parent, or adult child. Hospitals often turn to close relatives informally for routine calls, but when a genuinely hard question arises, disagreements among family, delays in treatment, or a probate court guardianship proceeding can follow. Guardianship is expensive, time-consuming, and public, and a judge picks the decision-maker instead of you. A proxy avoids all of that. It costs nothing, takes minutes, and puts the choice of who speaks for you in your own hands while you are healthy enough to make it.

1
General Court of Massachusetts. Massachusetts Code Chapter 201D Section 2 – Appointment of Health Care Agents; Execution of Proxy; Alternate Agents
2
Mass.gov. Download the Massachusetts Health Care Proxy Form
3
National Institute on Aging. Choosing a Health Care Proxy
4
General Court of Massachusetts. Massachusetts Code Chapter 201D Section 4
5
General Court of Massachusetts. Massachusetts Code Chapter 201D Section 5
6
U.S. Department of Health & Human Services. Personal Representatives
7
General Court of Massachusetts. Massachusetts Code Chapter 201D – Health Care Proxies
8
Mass.gov. MOLST Transition to POLST
9
General Court of Massachusetts. Massachusetts Code Chapter 201D Section 7