Advance Directives: Make a Plan Before It’s Too Late

Sarah Shepard Care Dimensions Manager of Psycho-Social Support Services

Sarah Shepard, LICSW, Care Dimensions Manager of Psycho-Social Support Services

Advance directives are empowering! That’s why on April 16, organizations in all 50 states participate in National Healthcare Decisions Day, an initiative designed to inspire, educate, and empower the public and health care providers about the importance of advance care planning.


These documents allow us to continue to have input in our medical care, even when we are unable to speak for ourselves. Several studies reveal that only one-third of U.S. residents have advance directives in place, however. As someone who practices hospice social work, I often see problems that can arise when a patient has not clearly – and legally – expressed his/her wishes for medical treatment.


For example, we were seeing a hospice patient who was in his 90s and very close with his family. He had a terrific sense of humor, was considered a role model in his community, and was loved by many. He was very clear with his team and family that he did not want to talk about his terminal status or his wishes for medical care or funeral arrangements. While he had named a family member as his Health Care Agent/Proxy to make decisions, this person had no idea what our patient wanted. Did he want to be resuscitated? Receive IV fluids? Go to the hospital or stay at home through his lifetime? His Agent struggled as our patient became more ill and less communicative.  His family struggled emotionally, wondering if they were going to make the right decisions when the time came.


Fortunately, you and your loved ones do not have to endure this kind of conflict. You can have control over your medical care by discussing your wishes with the people in your life and give them the direction they’ll need if a time comes when you cannot make the decision yourself.


The theme for the 2016 National Healthcare Decisions Day is, “It Always Seems Too Early, Until It’s Too Late.” Here’s what you need to know about advance directives:


Health Care Proxy or Health Care Power of Attorney:  A legal document that names who you would like to make health-related decisions for you in the event you are unable to do so. This can be temporary while you are recovering from an illness, or permanent. Your Health Care Agent (a.k.a. Health Care Proxy) cannot make any decisions for you until a physician deems that you need someone to assist or make decisions for you. Medical professionals can encourage your Agent to continue to consult you and engage you in decision making until this capacity can be restored to you fully. Your Health Care Agent and primary care physician should have a copy of this document on record. You can download the Massachusetts Health Care Proxy form and instructions; if you have residences in more than one state, you should consult a legal or medical professional to ensure the form you complete will best suit your needs.


Care Dimensions Mary Crowe explains advance directivess

Care Dimensions offers community education programs about advance directives.

MOLST (Medical Orders for Life-Sustaining Treatment): A document to fill out with your physician when health changes are happening that will tell your medical team what treatments you want to pursue. This document covers resuscitation orders and additional steps toward that decision. It requires a physician’s signature and should be discussed with your primary care physician. A copy should be made available to your Health Care Agent. Similarly, you should check with a legal or medical professional to ensure this form will be honored in other states you frequent. See more on our “Planning Ahead” page.


Living Will (e.g., Five Wishes or Honoring Choices Guide): Living wills are not legal documents in Massachusetts, but they can be used to help explain your wishes and guide your Agent’s actions. Five Wishes is a well-known guide that is available and legal in many states. It assists people in naming their Health Care Agent and having crucial but delicate conversations about health care wishes. Another resource is available at, which can also help guide you through the process. Copies of all documents should be given to your primary care physician and Health Care Agent. For links to more information, see Planning Ahead Resources.


Who Should Have Advance Directives?

Anyone over the age of 18 should have a Health Care Proxy. In Massachusetts, next of kin are not automatically designated to make health care decisions in the event where we are unable to do so.  Advance directives ensure that the person you have chosen will be legally able to make decisions with or for you.


How Do I Choose My Health Care Agent/Proxy?

People have differing views of how health care is approached or pursued; choose the person who will make decisions regarding your health that will most closely honor your wishes. There may be circumstances when it is most reasonable for someone other than a family member to be chosen.

Being chosen as someone’s Health Care Agent is an enormous responsibility and one that, while an honor, can be challenging at times. Have conversations with this person about your thoughts and wishes on your health care. This honor should be discussed as views on health care change over time.  While these conversations are serious ones, they don’t have to be lengthy or painful.  They can also be navigated with the assistance of a legal or medical professional.


What if I Change My Mind?

If you change your mind, complete a new Health Care Proxy or MOLST and the most recently dated form is the one that should be honored.


For a free copy of Five Wishes, or to arrange a community education program about advance directives, call 978-774-7566 or email


Sarah Shepard is Manager of Psycho-Social Support Services for Care Dimensions.

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