Massachusetts: Health Care Power of Attorney Requirements
The short answer
A competent Massachusetts adult may appoint a health care agent in a written health care proxy signed personally or at the adult's direction in front of two adult witnesses. Both witnesses must sign and affirm that the principal appeared at least 18, of sound mind, and free of constraint or undue influence; the named agent cannot witness. Notarization is not an alternative or an extra requirement. The agent acts only after the attending physician makes a written incapacity determination.
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This is the general rule in Massachusetts. Ezel applies current Massachusetts law to your specific facts and answers with citations to the statutes.
| Governing law & document | Massachusetts Health Care Proxy Law, Mass. Gen. Laws ch. 201D. It creates a standalone health care proxy; § 4 requires the document to identify the principal and agent, grant health-care-decision authority, state any limits, and make the authority spring on a § 6 incapacity finding. Chapter 201D does not publish a mandatory statutory form. |
|---|---|
| Who can sign | Every competent adult may execute a proxy (§ 2), and adults and properly executed proxies are presumed competent/valid unless a court rules otherwise. It must be written and signed by the adult or at the adult's direction in the two witnesses' presence. Section 2 does not make dating or notarization an execution condition. |
| Witnesses or notary | Two adult witnesses; no notary option. The proxy must be signed 'in the presence of two other adults who shall subscribe their names as witnesses,' and both must make the required written affirmation (§ 2). Notarization neither replaces the witnesses nor must be added to them. |
| Who can't witness or serve | The named health care agent may not witness (§ 2); Chapter 201D adds no relative, heir, or provider bar for witnesses. Agent: a facility operator, administrator, or employee generally may not be appointed by a person who is then a patient/resident or applicant to that facility, unless related to the principal by blood, marriage, or adoption (§ 3). |
| When the agent can act | Springing only. Authority begins after the attending physician determines in writing, under accepted medical judgment, that the principal lacks capacity to make or communicate health care decisions (§ 6). If incapacity is due to mental illness or developmental disability, that physician must have or consult someone with relevant specialized training. A physician-agent cannot make the capacity finding. |
| Agent's powers & limits | The agent may make 'any and all health care decisions' the principal could make, expressly including life-sustaining treatment, subject to the proxy's express limits (§ 5). The agent follows the principal's wishes (including religious/moral beliefs), then best interests if unknown. Even after incapacity is found, the principal's objection prevails unless a court finds the principal lacks capacity (§ 6). |
| How to revoke | The principal may revoke by oral or written notice to the agent or a provider, or any other act showing specific intent (§ 7); capacity to revoke is presumed unless a court rules otherwise. A later proxy revokes the earlier one. Divorce or legal separation automatically revokes a spouse-agent appointment. |
| Out-of-state directives | Massachusetts preserves the enforceability of a proxy or similar instrument executed in another state or jurisdiction in compliance with that jurisdiction's law (§ 11), subject to the provider/facility protections and duties in §§ 14-15. |
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Massachusetts calls this document a health care proxy. It is governed by
Mass. Gen. Laws chapter 201D and stands apart from a personal directive or
"living will." The proxy names an adult agent to make health care decisions only
after the principal loses decision-making capacity.
Requirements one by one
Governing law and document
Chapter 201D does not supply a mandatory model form. Instead, § 4 states what the
proxy must contain: it must identify the principal and agent, show the intent to
delegate health care decisions, describe any limits, and say the agent's authority
begins after the § 6 incapacity determination.
Who can sign
"Every competent adult" may execute a proxy (§ 2). The law presumes every adult
competent and every proxy properly executed unless a court decides otherwise.
The proxy must be written and signed by the adult, or by someone acting at the
adult's direction, while both witnesses are present.
Witnesses or notary
Massachusetts requires two adult witnesses. Section 2 says the proxy must be
signed "in the presence of two other adults who shall subscribe their names as
witnesses." Each witness must affirm in writing that the principal appeared at
least 18, of sound mind, and free of constraint or undue influence.
There is no notary alternative in § 2. A notary cannot replace either witness,
and notarization is not required in addition to the witnesses. The statute also
does not make dating the proxy an execution condition.
Who can't witness or serve
The one express witness bar is important: "[n]o person who has been named as
health care agent" may witness (§ 2). Chapter 201D does not add the common bans on
relatives, heirs, or care providers serving as witnesses.
Agent eligibility is narrower in a facility setting. Under § 3, a facility's
operator, administrator, or employee generally cannot be appointed by someone
who is then a patient, resident, or applicant there, unless that proposed agent is
related to the principal by blood, marriage, or adoption.
When the agent can act
The proxy is springing. Section 6 says authority begins only after the
attending physician determines in writing that the principal lacks capacity "to
make or to communicate health care decisions." The writing must address the
cause, nature, extent, and probable duration of the incapacity and go in the
medical record.
If mental illness or developmental disability causes the incapacity, the
attending physician must have — or consult a professional who has — relevant
specialized training or experience. A physician who is also the named agent may
not make the capacity finding. If capacity returns, the agent's authority stops;
it can restart after a later loss of capacity.
Agent's powers and limits
Section 5 is broad: the agent may make "any and all health care decisions" the
principal could make, including decisions about life-sustaining treatment. The
proxy may expressly limit that authority. The agent uses the principal's wishes,
including religious and moral beliefs; if those wishes cannot be determined, the
agent uses the principal's best interests.
One safeguard is unusually explicit. Even after the physician's incapacity
finding, if the principal objects to the agent's decision, the principal wins
unless a court determines that the principal lacks capacity (§ 6).
How to revoke
Revocation is deliberately easy. The principal may tell the agent or a provider
orally or in writing, or use "any other act evidencing a specific intent to revoke"
(§ 7). Capacity to revoke is presumed unless a court rules otherwise. Signing a
later proxy also revokes the earlier one. Divorce or legal separation revokes a
spouse's appointment as agent.
Out-of-state directives
Section 11 preserves a proxy or similar instrument executed elsewhere if it
complied with the law of that state or jurisdiction. Enforcement remains subject
to the Massachusetts provider and facility rules in §§ 14-15.
What trips people up
- A notary is not a substitute for witnesses. Massachusetts requires two adult
witnesses; § 2 provides no notary alternative. - The agent cannot witness. Either the primary or alternate agent should stay
out of the witness lines. - The agent does not act immediately. The attending physician must first make
and record the written § 6 incapacity determination. - A facility insider may be barred from serving. Operators, administrators,
and employees face § 3's patient/resident/applicant restriction unless related. - The principal's objection can stop the agent. A physician's incapacity
finding alone does not override an objecting principal; that requires a court
capacity determination (§ 6).
Common questions
Does a Massachusetts health care proxy need to be notarized?
No. It needs two adult witnesses. Notarization cannot replace them (§ 2).
Can my agent also be a witness?
No. Section 2 expressly bars a named health care agent from witnessing.
When does my agent's authority begin?
After the attending physician makes the written incapacity determination required
by § 6. It ends if the physician determines you have regained capacity.
Can the agent decide about life support?
Yes, unless the proxy limits that power. Section 5 expressly includes decisions
about life-sustaining treatment.
Will an out-of-state proxy work in Massachusetts?
Section 11 preserves enforceability if it complied with the law where executed,
subject to Massachusetts §§ 14-15.
Statutes and sources
- Mass. Gen. Laws ch. 201D, § 2 — writing, signature, two witnesses, witness
affirmation, and agent-witness bar.
https://malegislature.gov/Laws/GeneralLaws/PartII/TitleII/Chapter201D/Section2
(accessed 2026-07-16) - §§ 3-4 — facility-insider agent restriction and required proxy contents.
https://malegislature.gov/Laws/GeneralLaws/PartII/TitleII/Chapter201D/Section3
(accessed 2026-07-16) - § 5 — agent authority, life-sustaining treatment, wishes, and best interests.
https://malegislature.gov/Laws/GeneralLaws/PartII/TitleII/Chapter201D/Section5
(accessed 2026-07-16) - § 6 — written attending-physician incapacity finding, regained capacity, and
the principal-objection rule.
https://malegislature.gov/Laws/GeneralLaws/PartII/TitleII/Chapter201D/Section6
(accessed 2026-07-16) - § 7 — revocation, later proxy, divorce, and legal separation.
https://malegislature.gov/Laws/GeneralLaws/PartII/TitleII/Chapter201D/Section7
(accessed 2026-07-16) - § 11 — foreign proxies.
https://malegislature.gov/Laws/GeneralLaws/PartII/TitleII/Chapter201D/Section11
(accessed 2026-07-16)
Source links
Every statute quoted above, linked, with the date we checked it.
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