Two things about Massachusetts health care documents catch people out, and both matter.
A health care proxy needs two witnesses and no notary. The word “notary” appears nowhere in the statute, and the state’s own form has no notary block.
A living will is not legally binding in Massachusetts. There is no living will statute here. If that is the only document you have signed, you have no legally recognized decision-maker.
Signing one
Under G.L. c. 201D § 2, a health care proxy must be:
- In writing
- Signed by you, or by someone else at your direction if you cannot sign
- Signed in the presence of two other adults, who subscribe their names as witnesses
The witnesses must affirm in writing that you appeared to be at least 18, of sound mind, and under no constraint or undue influence.
Your agent cannot be a witness. The state’s form goes further and has both witnesses declare that neither is the agent or the alternate, which is the safer practice even though the statute names only the agent.
Can a nursing home employee witness it?
Yes, and the common belief is wrong. Nothing in the chapter restricts who may witness beyond the agent.
The restriction is on who may serve as agent, and it is in a different section. An operator, administrator or employee of a facility cannot be your agent if you are a patient or resident there, or have applied for admission, unless they are related to you by blood, marriage or adoption.
That exception matters: an adult child who happens to work at their parent’s nursing home can still serve.
Massachusetts also imposes no special signing rule for people already living in a facility. Some states require an ombudsman witness. This one does not.
When your agent’s authority starts
Not when you sign it. Not when your family thinks you need help.
Your attending physician must determine that you lack capacity to make or communicate health care decisions. That determination must be in writing, must state the cause, nature, extent and probable duration of the incapacity, and must be entered in your permanent medical record.
An oral determination does not activate the proxy.
If the incapacity is due to mental illness or developmental disability, the physician must have, or consult someone with, specialized training. A physician who is your agent cannot make the determination. Notice must go to you, your agent, and any mental health facility director, both orally and in writing.
The provision almost nobody knows about
Even after a doctor finds you incapacitated, if you object to a decision your agent makes, your decision prevails unless a court determines you lack capacity.
Not a second doctor. A court.
And the proxy is a toggle. If you regain capacity, your agent’s authority stops, and resumes if you lose it again.
What your agent can and cannot do
Your agent can make any health care decision you could make, including about life-sustaining treatment, subject to any limits you write into the document.
Two powers worth knowing:
Your agent outranks everyone, including whoever holds your power of attorney. The statute says so directly.
Your agent gets your medical records, “notwithstanding any general or special law to the contrary.” That is the provision that defeats a HIPAA-based refusal.
The decision standard is two-tiered, and the order matters. Your agent decides first according to their assessment of your wishes, including your religious and moral beliefs. Only if your wishes are unknown do they fall back on your best interests. Your agent is not asked to substitute their own judgment about what is best for you.
Limits: no suicide or mercy killing; comfort care and pain relief can never be blocked; a physician may decline on moral or religious grounds but must transfer your care. And nobody can require you to sign a proxy as a condition of treatment or admission.
Why a living will is not enough
Massachusetts has no living will statute. The state’s own guidance says a personal directive or living will “is not legally binding on your doctors,” while urging people to write one anyway.
Both halves of that are true, and most guides only get the first half.
A written directive carries real evidentiary weight. The statute tells your agent to follow your wishes, and a signed document is the best evidence of them. In a 1986 case the SJC upheld a decision to withdraw artificial nutrition based on the patient’s informal prior oral statements. A signed, dated, witnessed document is stronger evidence than that.
So: the proxy is the operative document and the living will is the evidence that tells your agent what to do. Sign both. Never sign only the second.
The document EMTs will actually follow
This is the most practically important thing on this page.
Paramedics will not honor your health care proxy. They will not honor a living will either. Only a MOLST form or a Comfort Care/DNR Verification form is an actionable order in the field.
A family holding up a health care proxy when the ambulance arrives will get full resuscitation.
MOLST is a medical order, “similar to a prescription,” signed by both a clinician and the patient, and it is meant only for people with serious illness. It works immediately, regardless of capacity. A proxy is a legal document for every adult that works only after a finding of incapacity. They do different jobs and you may need both.
Massachusetts is replacing MOLST with the national POLST model in Spring 2027. Existing MOLST forms stay valid and will still be honored after the transition.
One warning: the old MOLST website domain is no longer the state program. It has been taken over by an unrelated commercial site. Use mass.gov.
Revoking it
Strikingly informal. You can revoke by telling your agent or any health care provider, orally or in writing, or by any act showing you intend to revoke, such as tearing it up. Signing a new proxy revokes the old one.
You are presumed to have capacity to revoke unless a court says otherwise. A physician’s finding of incapacity does not take that away.
A proxy is also revoked automatically by divorce or legal separation where your spouse is your agent. Note that legal separation counts here, which is the opposite of the power of attorney rule.
There is a trap in that. The statute revokes “a health care proxy,” meaning the whole document, and does not say your named alternate steps up. Someone who assumed their backup would take over may have no valid proxy at all. No Massachusetts appellate decision has resolved it. Sign a new one after a divorce or separation.
If you never signed one
Massachusetts has no default surrogate law. No statutory ladder of spouse, then adult children, then parents, of the kind most states have.
The statute lets providers rely on “responsible parties” for informed consent “to the extent permitted by law,” which grants no independent authority. For routine care, families are usually accommodated. For anything serious, contested, or involving withdrawal of life-sustaining treatment, the answer is guardianship in the Probate and Family Court.
That takes time your family may not have, needs a medical certificate dated within 30 days, requires personal service on the person, who cannot waive notice, and requires a finding that their needs cannot be met by less restrictive means.
Which is the payoff for signing a proxy: a guardian cannot revoke your health care proxy without court authorization, and your agent’s decisions take precedence over the guardian’s.
Rogers orders and antipsychotic medication
A guardian cannot consent to antipsychotic medication on their own. Under the 1983 Rogers decision, a committed patient is presumed competent to make treatment decisions until a judge finds otherwise, and no state interest justifies antipsychotics in a non-emergency without consent.
The court must find, using substituted judgment, that the person would have consented if competent. Not that it would be good for them. It must also approve a specific treatment plan, after a hearing, with counsel appointed for anyone indigent.
A Rogers monitor then ensures the plan is followed. It can be the guardian, or the court appoints someone. Approval cannot be withheld just because no monitor is available. Every order gets reviewed at least annually and carries an expiration date.
Separately, a guardian cannot admit someone to a nursing facility without a specific court finding that it is in their best interest, apart from a narrow 60-day exception that any interested person can defeat by objecting.
Common questions
Does a health care proxy need to be notarized in Massachusetts?
No. It needs two adult witnesses. The word “notary” appears nowhere in the statute and the state’s official form has no notary block.
Who cannot witness my health care proxy?
Your agent. The state’s own form goes further and excludes the alternate agent as well, which is the safer practice.
Can a nursing home employee witness it?
Yes. The restriction is on serving as your agent, not as a witness, and even that has an exception for relatives by blood, marriage or adoption.
Is a living will legally binding in Massachusetts?
No. Massachusetts has no living will statute and the state says a living will is not binding on physicians. It is still valuable as evidence of your wishes, which is what the statute tells your agent to follow.
Will EMTs follow my health care proxy?
No. Only a MOLST form or a Comfort Care/DNR Verification form is actionable in the field. A proxy or living will will not stop resuscitation.
Who decides when my proxy takes effect?
Your attending physician, in a written determination stating the cause, nature, extent and probable duration of the incapacity, entered in your permanent medical record. An oral determination is not enough.
Can I override my agent after being found incapacitated?
Yes. If you object to a decision, your decision prevails unless a court determines you lack capacity. A physician’s determination is not enough for that.
Does my health care agent outrank my power of attorney?
Yes. The statute gives health care decisions by your agent priority over anyone else, expressly including someone acting under a durable power of attorney.
Does divorce revoke a health care proxy?
Yes, divorce or legal separation, where your spouse is the agent. But the statute revokes the whole document and does not say the alternate steps up, so sign a new one.
What happens if I have no health care proxy?
Massachusetts has no default surrogate law. Families are usually accommodated for routine care, but a serious or contested decision typically requires a guardianship in the Probate and Family Court.
Statutory text quoted from G.L. c. 201D §§ 2, 3, 5, 6, 7, 10, 12, 13 and 17; G.L. c. 190B §§ 5-101, 5-303, 5-304, 5-306, 5-306A and 5-309; and G.L. c. 19A § 44. Case law from Rogers v. Commissioner of the Department of Mental Health, 390 Mass. 489 (1983); Superintendent of Belchertown State School v. Saikewicz, 373 Mass. 728 (1977); and Brophy v. New England Sinai Hospital, 398 Mass. 417 (1986). MOLST and POLST information from the Executive Office of Aging and Independence and the Department of Public Health. Law current as of September 5, 2026. The transition from MOLST to POLST is scheduled for Spring 2027. Whether a named alternate agent survives revocation by divorce has not been decided by any Massachusetts appellate court. General information, not legal advice.