By Patricia D. Stewart, Esq.
Medical Orders for Life-Sustaining Treatment, known as MOLST Forms, are now the law in Massachusetts. They can limit the type and extent of life-sustaining care you receive if you have a chronic illness or are at the end of life. By law, all seriously or terminally ill patients will be asked to indicate on the MOLST form their preferences for life-sustaining measures. Then the form, which is actually a doctor’s order, becomes part of the patient’s permanent medical record. For some, whose death is imminent and inevitable, this may be an appropriate way to convey their final wishes for healthcare; but for many more, whose life expectancies are unknown and unknowable, the MOLST questionnaire will require a patient to make premature choices about future healthcare that are likely to cause patient worry and confusion and create opportunities for abuse. But, take heart. There is a simple route around MOLST forms: it’s called a healthcare proxy. Here’s how it works:
WHAT IT IS. A health care proxy is a legal document that allows you to appoint someone to make healthcare decisions for you, if you are unable to make or communicate those decisions for yourself. People commonly and mistakenly associate healthcare proxies solely with end of life decisions; but the need to have someone decide medical questions for you, or for you to decide these questions for someone else, may also arise if you, or they, become incapacitated temporarily due to an accident or illness from which there will be a full recovery.
WHO IT INVOLVES. The person you appoint as your decision maker is called your “healthcare agent.” It is recommended that you also appoint someone to be your “alternate agent,” in case your first agent becomes unavailable. Your agent is authorized to make all medical treatment decisions for you to the same extent that you could make them for yourself, if you were able. But, unlike a MOLST form which takes effect immediately, your healthcare proxy takes effect to confer authority on your healthcare agent only after a doctor has determined that you do not have the capacity to make or communicate those decisions for yourself. Thus, healthcare decisions made for you will be the result of choices your agent makes in the circumstances that exist when a decision is needed, rather than as the result of a premature MOLST prediction made months or years in advance. A healthcare proxy is active only while you are unable to make decisions for yourself; it becomes inactive, ending your agent’s authority, when you regain decision-making ability. By comparison, a MOLST form never expires on its own.
HOW TO GET ONE. Healthcare proxy forms are available in hospitals, nursing homes, doctor’s offices, and online.
You do not need a lawyer to prepare a healthcare proxy. Just sign the proxy form in the presence of two witnesses, who are someone other than your healthcare agent and alternate agent. Then give a copy of the form to your doctor(s), agent, alternate agent, and to any hospital or healthcare facility where you are currently, or are likely to be, admitted in the event of an illness or health emergency. Tell all healthcare providers to put the form in your permanent medical file, and keep a copy for yourself.
INSTRUCTIONS. In the healthcare proxy, you can instruct your agent on how you want decisions to be made for you. For example, you may include instructions based on your religious or moral beliefs and pro-life values concerning healthcare and end of life choices.
CANCELLATION. You can cancel your healthcare proxy for any reason by: (1) telling your doctor or agent, (2) signing a new healthcare proxy, or (3) doing anything else that shows you want to cancel it.
Caution: If you change your mind about the people you selected in your healthcare proxy, do not just cross out their names and add new ones as this may cancel the entire document. Instead, sign a new proxy.
WHEN. It is never too soon to sign a healthcare proxy. Having a healthcare proxy in place before you need it is the surest way to relieve some of the stress that accompanies any medical crisis. For decision makers, it eliminates guesswork over choices that may sustain or end a life; for you, it assures medical choices based on your beliefs, made in response to actual circumstances and not as the result of outdated forecasts. And, as an added bonus, a healthcare proxy protects you from the bother of MOLST.