Medical emergencies do not always unfold the way we expect, and written instructions cannot anticipate every decision a doctor may face. A doctor may not follow an advance directive if it is invalid, unclear, inconsistent with accepted medical practice, or contrary to the doctor’s moral or religious beliefs.
In Massachusetts, the type of document also matters because a health care proxy carries legal authority, while a living will generally serves as evidence of your wishes rather than a legally binding directive.
What Is an Advance Directive?
An advance directive records your preferences for medical care or identifies someone who can make decisions if you cannot communicate. Two documents commonly associated with advance care planning are health care proxies and living wills.
A Massachusetts health care proxy allows you to appoint a health care agent. The agent’s authority begins after an attending physician determines that you lack the capacity to make or communicate health care decisions. Subject to any restrictions in the document, your agent can then make the same types of medical decisions you could make yourself.
A living will describes the treatment you would or would not want under certain circumstances, such as if you have a terminal condition. Massachusetts does not have a statute that makes living wills legally binding. Even so, a living will can provide valuable evidence of your preferences and guide your health care agent.
Can a Doctor Refuse to Follow Your Advance Directive?
A physician cannot simply disregard a valid decision made by your health care agent. Under Massachusetts General Laws Chapter 201D, Section 5, health care providers generally must comply with an agent’s decision as though you had made it yourself.
However, a doctor may decline or be unable to follow an instruction when:
- The health care proxy was not properly signed or witnessed.
- The document has been revoked or replaced by a newer proxy.
- Your agent requests care outside the authority granted in the proxy.
- The requested treatment is inconsistent with responsible medical practice or prohibited by law.
- The instruction is too vague to apply to your current condition.
- The doctor has a moral or religious objection to the decision.
A private facility may also decline a decision based on a formally adopted religious policy, provided the requirements of Massachusetts law are met.
When a physician objects on moral or religious grounds, Massachusetts law generally requires the patient’s transfer to another willing physician in the same facility or a reasonably accessible equivalent facility. If a transfer cannot be arranged, the physician must seek judicial relief or honor the agent’s decision.
Does an Advance Directive Apply While You Can Make Decisions?
No. As long as you can make informed medical decisions, your choices remain controlling. Your health care agent does not gain authority simply because you signed a proxy or were admitted to a hospital.
Even if a physician determines that you lack capacity, your objection to your agent’s decision generally controls unless a court has also determined that you lack the capacity to make health care decisions. If your attending physician later determines that you have regained capacity, your agent’s authority ends, and you resume making your own health care decisions.
How Can You Help Ensure Your Medical Wishes Are Followed?
Clear documents and direct conversations can reduce uncertainty when decisions must be made quickly. You can strengthen your incapacity plan by:
- Selecting an agent who understands your values and will speak firmly on your behalf
- Naming an alternate in case your first choice cannot serve
- Explaining your wishes to your agent, family, and medical providers
- Giving copies of your documents to your agent and physicians
- Reviewing your proxy after a divorce, diagnosis, or change in treatment preferences
Your health care proxy must meet Massachusetts signing and witnessing requirements. It should also identify any limits you want to place on your agent’s authority.
Why Is a Health Care Proxy So Important in Massachusetts?
Because a Massachusetts living will is generally not binding by itself, a health care proxy provides a stronger legal framework for decision-making. Your agent can evaluate the medical facts at the time, speak with your care team, and apply the preferences you previously discussed.
Using both documents can be helpful. The proxy appoints the decision-maker, while the living will gives that person written guidance about your treatment preferences.
Put Your Medical Wishes Into a Workable Plan
Advance directives should be clear, legally valid, and consistent with the rest of your estate plan. Surprenant, Beneski & Nunes, P.C. can help you prepare a Massachusetts health care proxy and supporting instructions that reflect how you want medical decisions handled. Contact us to discuss your incapacity and advance care planning needs.
