Massachusetts Medical Society: Medical Decision-Making

Medical Decision-Making

Medical Decision


Respecting patient autonomy is a critical tenant of medical care. Advance directives are the gold standard for honoring patient wishes in the case of incapacitation. Under Massachusetts law, patients may designate a Health Care Proxy (HCP), which allows another person to make medical decisions on behalf of a patient in the event that the patient is unable to make or communicate these decisions on their own.

Currently, if a patient becomes unable to make medical choices but lacks a HCP, caregivers and loved ones often must engage in a burdensome and time-consuming legal process to obtain guardianship, which would allow them to make medical decisions for the patient. Repeated court visits and the inherent care delays therein are not in the best interest of patients, as unnecessary time spent in an inpatient hospital bed exposes patients to increased risks. Additionally, these required legal processes create an unnecessary burden on providers, hospitals, and the legal system, causing hospital stays to be 58% longer and 23% more expensive according to research conducted by BIDMC. The total financial waste found by this study was $3.29 million in additional costs for that year.


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

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

The MMS supports:

  • Efforts to increase 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 that expedites the medical decision-making process for incapacitated patients lacking a health care proxy
  • Educational materials and programs aiming to improve understanding and to increase utilization of advance directives, health care proxies, and other appropriate health care documents pertaining to palliative care and
  • Policies and procedures that honor patients’ choices, goals, and values throughout life
  • Individuals being 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 national Physician Orders for Life Sustaining Treatment (POLST) Program, which assists individuals in communicating their preferences for life-sustaining treatments near the end of life
  • Establishment and maintenance of a 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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