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Massachusetts Living Will Form

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A Massachusetts Living Will is not recognized in the state of Massachusetts as a legal document. The state does believe, however, that this type of document would be very helpful for anyone who may be your Attorney in Fact or agent, to whom you entrust your medical care when you are no longer able to make your own decisions.

Medical Power of Attorney – Also known as a health care proxy, allows an individual to select a surrogate to make decisions on someone else’s behalf in reference to their medical needs.

How to Write

Step 1 – Treatment Preferences – Statement of Goals and Values:

  • The principal may make a statement with regard to what they hope to accomplish with this document

Step 2 – Preferences in case of terminal condition –

  • The Principal should carefully review the three available options with regard to what they would like their medical team to do in and end of life scenario.
  • Select and initial only one option

Step 3 – Preference in Case of Persistent Vegetative State –

  • The Principal must carefully review all options available should they become vegetative with no hope for recovery
  • Select only one option by initialing the line preceding the selected statement

Step 4 – Preference in Case of End‐Stage Condition –

  • The Principal must review all options in the event they find that they are in an end-stage condition
  • Select only one option by initialing the line preceding your selection

Step 5 – Pain Relief will be administered regarding your conditions or choices

Step 6 – Effect of Stated Preferences –

  • The Principal must review both options and select only one, by initialing the line preceding the preference

Step 7 –  Signature and Witnesses –

  • The Declarant/Principal, must review the statement in this section. If in agreement enter your signature
  • Date the signature in mm/dd/yyyy format
  • The Witnesses must review the brief statement about the Declarant/Principal. If in agreement:
  • Each respective witness must enter their signatures
  • Date their signatures in mm/dd/yyyy format
  • Provide their respective telephone numbers