Advance Directives

Written by Charlene Thurston, RN, ANP, Program Director, PASCON

Advance Directives are documents that you can choose to complete in order to provide directions for your health care, if you should become unable to communicate your wishes yourself, at the time that a health care decision must be made. There are two types of advance directives, sometimes combined in one document: health care proxies and living wills. In Massachusetts, health care proxies are legally binding, while living wills are not. However, if you feel strongly about having, or not having, certain treatments if there’s no hope for recovery, it’s still advisable to create a living will to help your health care proxy and physicians understand what your wishes would be. Advance directives are only used during the period in which you are unable to speak for yourself.

A health care proxy (or durable power of attorney for healthcare) is a person whom you appoint to make healthcare decisions on your behalf, if you should become unable to speak for yourself. Health care proxy forms are available at all healthcare organizations and attorneys’ offices, and may be completed by anyone over the age of 18. They are simple to complete, need only be witnessed by two people, and copies are as valid as the original documents. It’s probably a good idea for everyone over age 18 to appoint a health care proxy, but you must be sure to update it whenever you’d change your choice of proxy, for instance, when you marry or divorce. Without the appointment of a health care proxy, health care decisions generally fall to your next of kin in a specific order – spouse, adult children, parents, siblings.

A living will is a document in which you state your wishes regarding end of life treatments, which you do or do not want, if you should become unable to speak for yourself. While living wills are not legally binding in Massachusetts, they do serve to guide your health care proxy and your doctors, and are used as evidence of what your wishes would be.

Beyond the documents themselves, it’s most important that you think about your values and wishes, and that you talk about them to your families, proxies, and physicians. It’s also important that you continue to think about and talk about these issues regularly over the years, so that, if things change, everyone is kept informed of your wishes.

Copies of any advance directive documents should be given to your family, your proxy, and your physicians, as well as being kept in an easily accessible location in your home. In Nantucket, we also put a copy into your medical record at the hospital.

While not required, advance directives can really help relieve your family of the burdens inherent in end of life decisions if a crisis occurs. They can also ensure that you receive the type of care you desire.

If you’d like more detailed information about advance directives, you may call our PASCON Office at 508-825-8325. Written information, videos, and free educational consultations are available. Physicians, hospital and nursing home nursing and social service departments, and attorneys also have forms and can provide information and guidance about advance directives, as do the following websites:,,, or

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