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No family available. Need to choose between three who are trusted friends who would not be considered close personal friends. What should I ask them to help me make my choice? Under the Health Care Proxy Law (Massachusetts General Laws, Chapter 201D), any competent adult 18 years of age or over may use this form to appoint a Health Care Agent. You (known as the “Principal”) can appoint any adult
EXCEPT the administrator, operator, or employee of a health care facility such as a hospital or nursing home where you are a patient or resident UNLESS that person is also related to you by blood, marriage, or adoption I intend to create a Health Care Proxy according to Chapter 201D of the General Laws of Massachusetts. In making this appointment, I am giving my Health Care Agents the authority to make any and all health care decisions on my behalf, subject to any limitations I state in this document, in the event that I should at some future time become incapable of making health care decisions for myself.

2. Powers Given to Health Care Agent
a. I give my Health Care Agents full authority to make any and all health care decisions for me including decisions about life-sustaining treatment, subject only to the limitations I state below.
b. My Health Care Agents shall have authority to act on my behalf only if, when and for so long as a determination has been made that I lack the capacity to make or to communicate health care decisions for myself This determination shall be made in writing by my attending physician according to accepted standards of medical judgment and the requirements of Chapter 201D of the General Laws of Massachusetts.
c. The authority of my Health Care Agents shall cease if my attending physician
determines that I have regained capacity. The authority of my Health Care Agents shall recommence if I subsequently lose capacity and consent for treatment is required.

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Jeanne Gibbs, that is a perfect answer as far as I am concerned as a physician. Its the ability of you designee to charitably put their own wishes aside and speak for what yours would have been. Having correspondence of values about feeding tubes, keeping people alive in comas, about what 'excessive treatment' means, about discontinuing a ventilator, about 'what you would not have wanted' and having someone with the courage to make those decisions really helps a lot if it ever comes to needing to use that healthcare POA. Having several people on there usually just becomes a barrier to function. At most two!
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Excellent advice, Jeanne.
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I think when talking to your three friends, I would try to have discussions with each about end-of-life matters. Have they ever had experience with a dying relative? Did they agree with the decisions made, or what would they have done differently? What do they want for themselves? Get a feel with how similar your attitudes are.

If they disagree with you on some matters, would they be able to follow your wishes as they understand them? For example, if you feel one way about feeding tubes and they feel a different way, would they be able to honor your wishes about that matter?

And then get a feel for how comfortable each would be in making choices for you if the need arose. Is this something they would do willingly? Or only accept as an obligation?

I don't think the critical factor is how close they are to you, but how closely their attitudes about potential end-of-life match yours.
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Hi, Dave,
I'd like to follow up on GardenArtist's comments. GardenArtist commented that when he next redoes his health care Power of Attorney, he's going to name a specific physician to make the determination of decision making capacity, and how the decision will be made. By law, not only in Massachusetts but other states as well, the written determination can be made ONLY by the attending physician, not someone you, yourself name. If your incapacity is caused by a mental illness or a developmental disability, and if your attending doc is inexperienced with these issues, s/he must secure consultation with an expert who is. Second, he suggests naming a committee of 3 people to serve as a group. Under law, that's not possible either. The Proxy law says that you can name AN Agent, and AN Alternate Agent. And indeed, having a single person as the decision maker is one of the primary reasons the Health Care Proxy was passed in the first place, i.e., to prevent the potential conflict of a family in disagreement at a critical time. Better solutions are to 1) find a physician in whom you have solid confidence, and 2) name both an Agent and Alternate Agent who will do what you expect--and talk long and hard with them before naming them! Good luck. Mabaytrader
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Dave, something to think about....allowing an "attending physician" is probably the standard language; it's probably in our POAs as well. But last year I had 2 experiences with my father revealing that the attending physician was not skilled or knowledgeable in dealing with older people and made what I considered poor decisions.

Given that my niece has had experience on both floors and the ER, I discussed the situation with her and she agreed that based on standards at the hospital where she worked, the attending physician's actions were inappropriate and did NOT meet the standard of care for the specific medical issue. So I had the attending replaced and we don't see him any more.

When we have our POAs redone, I'm going to specify a specific physician, by name, with alternates, and specific circumstances under which the decision of lacking capacity will be determined.

Other than that, if you trust all 3 people equally, you could create the authority either (1) with power to act if (a) all three agree (b) a majority of 2 agree), or (2) each with independent authority to act.

I think it depends on the individuals, whether they know each other, how they could and would make decisions together, etc.
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