Family and physician concerns about legal rights and potential liabilities cause many patients who are incapacitated by illness or injuries to receive undesired treatment or have treatment withheld or withdrawn. Respirators, feeding tubes, and other measures are often used because there is no clear directive as to what the patient wants. Proper advance planning can ensure that a patient’s wishes are known and implemented. Health care proxies and advance directives (such as living wills) give patients who have become incapacitated control over their treatment. Health care proxies are legal documents, recognized in all 50 states, through which an agent or surrogate acts on behalf of the incapacitated patient to make treatment decisions. A living will also sets forth the patient’s wishes regarding end-of-life decisions, but many states do not recognize them as binding in the absence of a health care agent. To implement a living will, the patient needs to designate in writing an individual (and usually an alternate) to act on his or her behalf. (Living wills are not enforceable in Massachusetts.)

To ensure that your treatment wishes are followed in the event of incapacity, you should follow these steps to create a health care proxy:

• Identify a health care agent, and preferably an alternate agent as well. Select someone you trust who is willing and able to make crucial and often difficult decisions on your behalf.
   

• Determine your instructions. Examine treatment alternatives and discuss them with your physician, attorney, and family members. Put your wishes in writing. Make sure your agent fully understands your instructions and is prepared to carry them out.
   

• Draft your health care proxy. Consider a consultation with your physician or attorney. Sample forms are available through lawyers, many hospitals, and websites devoted to legal and health care matters. A commonly used form is available at www.massmed.org/ma_proxy. The proxy must identify you and your agent and include contact information. It should also state that your agent has authority to make health care decisions on your behalf and what limitations, if any, are imposed on the agent’s authority. Clearly state that the agent’s authority begins only if you are unable to make health care decisions.
   

• Have your health care proxy witnessed. Sign your health care proxy and have it witnessed by two individuals who are not your agents, caregivers, or relatives.
   

• Make sure your health care proxy is accessible. All too often, treating physicians don’t know whether their patients have health care agents, so give copies of your health care proxy to your physician and designated agent(s). Your spouse, partner, or family should also have a copy.
   

• Review your health care proxy regularly. Update your document as needed to reflect changes in your situation, including changes in your agent’s contact information or your treatment instructions. Review your health care proxy in connection with a regularly scheduled event such as an annual consultation with your physician.
   

Without a properly appointed health care agent, your spouse, partner, or other loved ones may not be able to participate in medical treatment decisions, leaving health care decisions up to people who don’t know your wishes. These simple steps will help ensure that you receive only the treatment you want.

David Stern is a graduate of Harvard College and Harvard Law School and the founder of online-registries, Inc. (OLR), a family of Web-based companies that provides digital storage of vital personal medical information, combined with the ability to access and share that information with designated healthcare providers in an emergency. med proxy is OLR's Internet registry for information about whom to contact regarding your healthcare treatment if you should be unable to make those decisions for yourself. For more information, visit http://www.online-registries.com or call (401) 841-5600.