Health care directive in Massachusetts: form, signing and who decides
The form, who can witness, who can be your agent and who decides if you have no directive in Massachusetts.
Checked against official sources: October 31, 2026.
Short answer
Health Care Proxy
- How to sign
- Signed in front of two witnesses (no notary)
- Who decides without a directive
- No
The document and its form
- Document
- Health Care Proxy
- Living will
No statutory living will
The living will is a separate document.
Massachusetts has no living will statute. You can write your wishes in the limits or instructions of your health care proxy for your agent to follow.
Law: M.G.L. c. 201D, §§ 2, 4; M.G.L. c. 201D, §§ 4, 5
Signing rules
- How to sign
Sign the health care proxy (or have someone sign at your direction) in front of two adult witnesses, who also sign. No notary is required. The proxy must name you and your agent, say the agent can make health care decisions for you, list any limits, and say the agent's authority starts when it is determined that you lack capacity.
- Who signs
Signed by you, or by another person at your direction, in the presence of two adult witnesses.
- Notary
- Not required
- Witnesses
- 2
- Who cannot witness
Two adults must sign as witnesses and affirm in writing that you appeared to be at least 18, of sound mind and under no constraint or undue influence. The person named as health care agent cannot be a witness.
Law: M.G.L. c. 201D, §§ 2, 4
Who can be your agent and what the agent can do
- Who cannot be your agent
Any adult, except an operator, administrator or employee of a facility where you are a patient or resident, or have applied for admission, when you sign, unless that person is related to you by blood, marriage or adoption.
Law: M.G.L. c. 201D, § 3
- When the agent starts
The agent's authority begins when your attending physician determines in writing that you lack capacity to make or communicate health care decisions, with the cause, nature, extent and likely length. If the cause is mental illness or developmental disability, the physician must have or consult someone with specialized training. The authority stops if you regain capacity and restarts if you lose it again.
Law: M.G.L. c. 201D, § 6
- Decisions an agent cannot make
The agent can make any health care decision you could, including about life-sustaining treatment, subject to limits you write in the proxy. If you object to the agent's decision, your decision prevails unless a court finds you lack capacity.
Law: M.G.L. c. 201D, §§ 5, 6
Revoking and conflicting documents
- Revoking your agent
You can revoke a health care proxy by telling your agent or a health care provider, orally or in writing, or by any other act showing you intend to revoke it. A new health care proxy also revokes the old one.
- Revoking your instructions
The same rules apply to any instructions in the proxy.
- Telling others
A physician who learns of the revocation must record it in your medical record and notify the agent and your known health care providers orally and in writing. An agent or nurse who learns of it must tell the attending physician.
- Divorce ends a spouse's authority
- Yes · Divorce rules in Massachusetts (Divorce Law Map)
- Conflicting documents
Health care decisions by your agent have priority over decisions of anyone else, including an attorney in fact under a durable power of attorney, unless the proxy or a court order says otherwise.
Law: M.G.L. c. 201D, § 5
Law: M.G.L. c. 201D, § 7
If you have no directive
- Who decides without a directive
Massachusetts has no statute naming a default family decision-maker. If you have no health care proxy, providers may rely on the informed consent of 'responsible parties' to the extent other law allows, or a court may appoint a guardian.
Law: M.G.L. c. 201D, § 16
Law: M.G.L. c. 201D, § 16
Other states, registry and medical orders
- Signed in another state
A health care proxy or similar document made in another state under that state's law is enforceable in Massachusetts, subject to the conscience rules in sections 14 and 15.
Law: M.G.L. c. 201D, § 11
- POLST (medical orders)
Massachusetts Medical Orders for Life-Sustaining Treatment (MOLST); the state is moving to the National POLST model (MassPOLST) in Spring 2027
Free notice: revoke or change a health care directive
Free help in Massachusetts
- Court Service Centers (Massachusetts Trial Court, free help)
- Mass.gov: File for guardianship of an incapacitated person
- Mass.gov: Massachusetts Health Care Proxy form
- Find free legal aid at LawHelp.org
Report abuse or exploitation
Adult Protective Services: Executive Office of Aging & Independence (adults 60+); Commission for the Protection of Persons with Disabilities (adults 18-59 with disabilities, 1-800-426-9009) · (800) 922-2275
Questions about powers of attorney in Massachusetts
How do I sign a health care directive in Massachusetts?
Sign the health care proxy (or have someone sign at your direction) in front of two adult witnesses, who also sign. No notary is required. The proxy must name you and your agent, say the agent can make health care decisions for you, list any limits, and say the agent's authority starts when it is determined that you lack capacity.
Who decides my health care if I have no directive in Massachusetts?
Massachusetts has no statute naming a default family decision-maker. If you have no health care proxy, providers may rely on the informed consent of 'responsible parties' to the extent other law allows, or a court may appoint a guardian (M.G.L. c.