Care Decisions

A time may come, because of an illness or accident, when a patient is no longer able to make his or her own decisions about medical care. There are several documents, called Advance Directives, that patients can prepare in advance of illness to ensure that their wishes are protected and fulfilled. There is also an online resource called The Conversation, designed to help families start a conversation with loved ones about end-of-life care.

Advance Directives

Advance Directives are forms that record a patient's instructions and choices for receiving or withholding medical treatment. Patients receive the same quality of health care whether or not they have completed these forms. If a patient becomes unable to make decisions and does not have advance directives in place, a family member or other person close to the patient may be asked to make decisions based on what they believe the patient would want. For patients under age 18, a parent or guardian usually makes decisions about their medical care. Completed advance directive forms can be given to one's doctor, nurse, or admitting officer, and a copy can be placed in one's medical record as well.

Health Care Proxy

Under Massachusetts Health Care Proxy Law, a patient can name another person to make decisions about health care for that patient. This person becomes the patient’s health care agent. He or she may act for the patient only if the doctor determines in writing that the patient is unable to make or communicate personal health care decisions. The agent would then have the legal authority to make all health care decisions for the patient, including decisions about life support treatments. He or she would be entitled to information and records from the doctor to help make decisions.

The Health Care Proxy Law also allows the patient to put limits on the agent's authority, such as specifying what types of medical care the patient would or would not want. The patient can name an agent by completing a Health Care Proxy form, which is available in the admission packet or upon request from a nurse. Before you complete the form, it’s a good idea to discuss the matter with your doctor, with family members, and with the person you’ve named as your health care agent. Download form

Living Will

A Living Will provides doctors, family members, and others close to a patient with written instructions describing the patient's views and choices about possible future medical treatment. It is important for patients to leave written instructions in particular regarding life-sustaining care, including the use of life-sustaining equipment, ventilators, respirators and dialysis, as well as the use of feeding or gastro tubes. The Living Will allows patients to record their wishes regarding organ donation and also record if they want to refuse aggressive medical treatment and instead opt for palliative care

The Living Will does not carry the same legal authority as a Health Care Proxy in the state of Massachusetts.

Ethics Advisory Committee

The NSMC Ethics Advisory Committee is available for consultation with individuals and families facing patient care dilemmas with no easily identified solutions.