1. End of Life Decision Making May 19, 2016 Massachusetts Continuing Legal Education
Kenneth J. Vacovec, Esq.
Vacovec, Mayotte & Singer LLP
255 Washington Street, Suite 340
Newton, MA USA
T: (617)
F: (617)

2. Massachusetts Legislation
“An Act Providing for the Execution of Health Care Proxies by Individuals”
December 18, 1990
15 Years after California first enacted a “Living Will” statute
By 1992, every State and the District of Columbia had a Living Will or Health Care Proxy statute.

3. Why a Need for health care proxies or a living will?
Medical technologies in the 1950’s and 1960’s were now able to prolong lives by artificial means of nutrition and hydration.
Before 1930, most people in the United States died in their own homes, surrounded by family, and comforted by clergy, neighbors, and doctors making house calls.
By 1977 seventy percent of deaths occurred in hospitals.

4. The Judicial background
NEW JERSEY
In Re Quinlan (1976)
SJC Decisions
Belchertown State School v. Saikewicz (1977) Substituted Judgment Doctrine
Brophy v. New England Sinai Hospital Inc. (1986)
United States Supreme Court
Cruzan v Director, Missouri Department of Health (1990)

5. The legislative response in 1990
Living Wills
Generally included vague terms
Could not cover all medical situations
Health Care Proxy
Separated from the roll of an Attorney-In-Fact
Appoints one person to make health care decisions
Based upon that persons relationship to the principal
With knowledge of the principals wishes, religious beliefs, and moral decisions

6. Current Massachusetts health care proxy
M.G.L. 201D – (2010)
A competent adult (principal) appoints another person (Health Care Agent) by executing a Health Care Proxy.
Authority to make health care decisions on the principals behalf.
After the determination the principal lacks the capacity to Make or Communicate health care decisions

7. Continued… The determination is made: By the attending physician
In writing
According to accepted standards of medical judgment
Entered into the principals permanent medical record

8. HARVARD MEDICAL DIRECTIVE
Created by Dr. Ezekiel Emanuel and Dr. Linda Emanuel Emanuel. 
More specific and extensive than previous living wills predecessors. Provides six case scenarios and commonly considered medical procedures associated with each scenario.
Allows individuals to decide in advance which treatments are wanted or not wanted under those circumstances.

9. Medical orders for life sustaining treatment
(MOLST)
MOLST authorized under Chapter 385, Section 43 of the Acts of 2008
Standardized Form
Translates a patient’s preferences for life sustaining treatments
Into valid medical orders
To be honored by all health care professionals
A new standard practice expanded statewide in April, 2012 by the Executive Office of Health and Human Services.
Endorsed by all major medical groups.