Advance Medical Directives

What is an Advance Medical Directive? It is a legal document that allows you to name someone you know and trust to make your health care decisions if, for any reason and at any time, you become unable to make or communicate those decisions. This person is your Health Care Agent. To pick up a Health Care Proxy form, please visit Nantucket Cottage Hospital’s Social Services Department or call (508) 825-8196.

Types of advance medical directives:

  • Health Care Proxy is a simple legal document that allows you to name someone you know and trust to be your agent and to make health care decisions for you. It can be completed without an attorney or notary.
  • Durable Power of Attorney designates a person to act on your behalf to make financial, as well as medical, decisions. This designation must be notarized.

Who can fill out a Health Care Proxy?
Any mentally competent adult 18 years of age or over may complete a Health Care Proxy to appoint a Health Care Agent.

When should I complete a Health Care Proxy?
Now. If you become unable to make decisions, your family, friends and health care providers should understand your choices.

Who can I name as my Health Care Agent on a proxy?
You should choose a close family member or friend who will be available to communicate with your caregivers. This person cannot be an employee, administrator, or operator of a facility, such as a hospital or nursing home where you are a patient, unless that person is also related to you by blood, marriage or adoption.

What should I do with the completed proxy?
Keep the original where it can be found easily (not in a safe deposit box). Give copies of the completed proxy to:

  1. Your physician
  2. Your Health Care Agent, and an alternate if you agent is not available
  3. Other close friends or family members

When is my proxy revoked?

  • When you create another one
  • If your spouse is your agent and you divorce or legally separate
  • When you notify your agent or physician, orally or in writing, that you want to revoke it
  • When you do anything that shows clearly that you want to revoke it, i.e. tear it up, destroy it, cross it out, or tell other people that it is no longer valid

What can my Health Care Agent do?

  • Make decisions about your health care only when you cannot
  • Consent to, or refuse, any medical treatment
  • Get any medical information necessary to make informed decisions for you

To be sure that your Health Care Agent knows what is important to you, discuss these things together:

  • Where you want to receive care
  • What caretakers you want
  • Your family involvement
  • Your religious beliefs
  • Financial concerns
  • When, or when not, to prolong your life
  • Pain or suffering
  • Organ donations

Discuss your feelings about certain forms of medical treatments, such as:

  • Life-sustaining treatment
  • Cardiopulmonary resuscitation (CPR)
  • The use of intravenous therapy and/or feeding tubes to administer food, water or medicine
  • Breathing machines
  • Kidney dialysis

When can my agent make decisions for me?

When your physician decides, in writing, that you are unable to make decisions about your health care, and after fully considering all medical information about your condition.

When you are admitted to Nantucket Cottage Hospital, you will be asked:

  • If you have a Health Care Proxy
  • If you want information about the proxy
  • If you want to complete a proxy

To pick up a Health Care Proxy form, please visit Nantucket Cottage Hospital’s Social Services Department or call (508) 825-8196.

If you have completed a Health Care Proxy, you should bring a copy of it to the hospital. It will be placed in your hospital record. If you have made changes to your proxy, you should bring the new copy.