Massachusetts Medical Society: Medical Decision-making

Medical Decision-making

Medical Decision


Respecting the autonomy of the patient is a critical tenant of medical care. As such, advance directives are the gold standard for achieving means to honor patient wishes in the case of incapacitation. In Massachusetts law, patients may designate a Health Care Proxy (HCP). This designation allows another person to authorize medical decisions on behalf of a person in the event that they are unable to make choices for themselves.

Currently, if a patient becomes unable to make medical choices but lacks a designated HCP, then caregivers and loved ones must often engage in a burdensome and time-consuming legal process to obtain guardianship. Repeated court visits and the inherent care delays are not in the best interest of the patients. Unnecessary time spent in an inpatient hospital bed exposes patient’s to increased risks such as hospital-acquired infections and delays in critical rehabilitative care. Additionally, they create an unnecessary burden on providers, hospitals, and our already-taxed legal system.

The process of obtaining guardianship is associated with a hospital stay that was 58% longer and 23% more expensive, according to research at Beth Israel Deaconess Medical Center. For the 51 patient cases researchers reviewed, this totaled $3.29 million in additional costs.


The Massachusetts Medical Society believes advanced care directives and health care proxies bolster the key medical tenets of providing high-quality, timely care and respecting patient autonomy.

The MMS believes that establishing a surrogate decision-maker hierarchy will improve patient care by alleviating the stresses and delays inherent with the current process.

The MMS supports:

  • Increased completion of health care proxies and the development of a Health Care Proxy registry, available to physicians, other providers, and appropriate entities, with 24/7 secure access.
  • Legislation to address the need to expedite the medical decision-making process for incompetent patients lacking a health care proxy
  • Physician and public education materials and programs to improve understanding of and increase utilization of advance directives, health care proxies and other appropriate health care documents, palliative care, and policies and procedures that uphold the individuals’ choice, goals, and values throughout life
  • individuals be allowed to maintain control of their treatment by executing a written document specifying instructions and desires regarding their medical care
  • Statewide dissemination and adoption of the Massachusetts Medical Orders for Life Sustaining Treatment (MOLST) Program, which assists individuals in communicating their preferences for life-sustaining treatments near the end of life.
  • National database for advance directives


The Massachusetts Medical Society presented testimony in support of the current legislation to allow for an improved surrogate decision-making structure for incapacitated patients who do not have health care proxies.

The MMS has partnered with Honoring Choices Massachusetts to provide clinicians and patients with up-to-date care planning information, documents and discussion guides.


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