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It is a simple, legal document that enables a patient to
appoint someone they trust to make health care decisions if the
patient is unable to do so. These decisions include life-saving
procedures such as CPR, life-sustaining treatments such as tube
feedings and respirators, as well as other procedures such as consent
for surgery, blood transfusions, pain medications and other routine
tests.

In Massachusetts, the Living Will is not a replacement for a Health
Care Proxy, as in other states. The person you choose as your Health
Care Proxy should be someone who knows what decisions you would
make for yourself if you were able to do so. Most people choose
a relative or close friend.
The Health Care Proxy is a simple legal document that allows
you to name someone you know and trust to make health care decisions
for you if, for any reason and at any time, you become unable to
make or communicate those decisions. It is an important document,
however, because it concerns not only the choices you make about
your health care, but also the relationships you have with your
physician, family and others who may be involved with your care.
Read this and follow the instructions to ensure that your wishes
are honored.

Under the Health Care Proxy Law (Massachusetts General Laws, Chapter
201D), any competent adult 18 years of age or over may use this
form to appoint a Health Care Agent. You (known as the "Principal")
can appoint any adult EXCEPT the administrator, operator or employee
of a health care facility such as a hospital or nursing home where
you are a patient or resident UNLESS that person is also related
to you by blood, marriage or adoption.
Your Agent will make decisions about your health care only
when you are, for some reason, unable to do that yourself. This
means that your Agent can act for you if you are temporarily unconscious,
in a coma, or have some other condition in which you cannot make
or
communicate health care decisions. Your Agent cannot act for you
until your doctor determines, in writing, that you lack the ability
to make health care decisions. Your doctor will tell you of this
if there is any sign that you would understand it.
Acting with your authority, your Agent can make any health care
decision that you could, if you were able. If you give your Agent
full authority to act for you, he or she can consent to or refuse
any medical treatment, including treatment that could keep you alive.

Your Agent will make decisions for you only after talking with your
doctor or health care provider, and after fully considering all
the option regarding diagnosis, prognosis and treatment of your
illness or condition. Your Agent has the legal right to get any
information, including confidential medical information, necessary
to make informed decisions for you.

Your Agent will make health care decisions for you according to
your wishes or according to his/her assessment of your wishes, including
your religious or moral beliefs. You may wish to talk first with
your doctor, religious advisor, or other people before giving instructions
to your agent. It is very important that you talk with your Agent
so that he or she knows what is important to you. If your Agent
does not know what your wishes would be in a particular situation,
your Agent will decide based on what he or she thinks would be in
your best interests. After your doctor has determined that you lack
the ability to make health care decisions, if you still object to
any decision made by your Agent, your own decisions will be honored
unless a Court determines that you lack capacity to make health
care decisions.

Your Agent's decisions will have the same authority as yours would,
if you were able, and will be honored over those of any other person,
except for nay limitation you yourself made, or except for a Court
Order specifically overriding the Proxy.
Your Health Care Proxy is revoked when any of the following
four things happens
| 1. |
You sign another Health
Care Proxy later on. |
| 2. |
You legally separate
from or divorce your spouse who is named in the Proxy as your
Agent. |
3. |
You notify your agent,
your doctor, or other health care provider, orally or in writing,
that you want to revoke your Health Care proxy. |
| 4. |
You do anything else that clearly
shows you want to revoke the Proxy, for example, tearing up
or destroying the Proxy, crossing it out, telling other people,
etc. |
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