ParentCare » Vol. 9


Advanced Health Decisions

By Frederick M. Misilo, Jr., Esq.

Yesterday, I was traveling on an interstate coming back to Central Ma from a meeting on the North Shore. It was a bright afternoon and the traffic was moving at an acceptable pace. Then, the pace slowed and eventually stopped. Within minutes, sirens from police vehicles and fire apparatus approached. Traffic pulled over to the left side, the emergency vehicles sped by my right side. After ten or fifteen minutes, the traffic began to crawl forward. In front of me, I could see a crowd had formed on an overpass. They were peering down at the interstate below them. Some were pointing. As I approached, I could see what they were looking at. There had been some type of massive collision, a violent crash. The remnants of one or more vehicles were strewn over a large area. As I wound through the accident scene, I thought, “My God, a few minutes before this – these people were just traveling along as I had been doing. Yet, in a brief second, things went terribly wrong.”

We don’t like to think about this type of thing happening to us. We are in a constant state of denial. It’s like that with chronic illnesses as well. Without warning, you are unable to communicate with your spouse or your children. You can’t communicate your health care decisions. Sometimes, we do get some warning, but don’t take the necessary steps to put our thoughts and wishes about health care decision-making down in writing.

As you may have heard, a Massachusetts health care proxy allows you to name a health care agent to make medical decisions for you when it has been determined by your physician that you are either unable to make or unable to communicate your health decisions due to a physical or mental impairment. More important than merely naming an agent and an alternate agent to make your decisions in a health care proxy is that you should make sure that your wants, needs, and wishes with regard to future medical decision-making is known to the individuals you name as your health care agents. One effective way of doing this is through a document called a Personal Wishes Statement which is made part of your health care proxy. I have provided a sample Personal Wishes Statement below. When there is no hope of recovery from a condition and when the provision of medical treatment merely prolongs the dying process, you have the ability, through the use of your Personal Wishes Statement, to give direction to your health care agent as to what the nature and extent of the treatment you do and don’t want.


I, _____________, sign this form for the purpose of offering my Health Care Agent guidance so that he or she may make decisions based on an assessment of my personal wishes as well as medical information provided by my physicians. My Health Care Agent has authority to make such decisions in accordance with Massachusetts law. This form is an expression of my wishes and not legally binding.

If there is no hope for my recovery and, in the opinion of my physician, I will die without life sustaining treatment that only prolongs the dying process, I ask that my Health Care agent consider the following: (initial the lines that express your wishes)

____ If my heart stops, I do not want to be resuscitated (CPR).

____ If I stop breathing, I do not want to be on a breathing machine.

____ Treatment should be given to maintain my dignity, keep me comfortable and relieve pain even if it shortens my life.

____ My physician may withdraw or withhold treatment that only serves to prolong the dying process:

____ If I cannot drink, I do not want to receive fluids through a needle or catheter placed in my body unless necessary to keep me comfortable.

____ If I cannot eat, I do not want a tube inserted in my nose, mouth or surgically placed to give me food.

____ If I have an infection, I do not want antibiotics administered to prolong my life without hope of cure unless necessary to keep me comfortable.

____ If possible, I would like to die at home with hospice care, if needed.

____ Unless necessary for my comfort, I would prefer NOT to be hospitalized.

____ My faith tradition is ______________________________. My spiritual contact person is ______________________.

____ I do not wish spiritual support.

____ If possible, I wish to be an organ donor.

____ Following is additional guidance for my Health Care Agent’s consideration.


Signature: __________________________________ Date:___________________

For individuals who are living at home whose condition is such that they do not wish to be resuscitated, they can arrange with their doctor a Comfort Care/Don Not Resuscitate (DNR) Verification Order. This form is available from your doctor and can be downloaded from The form must be signed by your doctor. The original form, a copy of the form, or an identifying bracelet must be present for your wishes to be honored.

Additional information on advanced health care planning can be found at a number of local resources including and the Hospice and Palliative Care Federation of Massachusetts at 781-255-7077.

Comments are closed.