Understanding Advance Directives, Health Care Proxies, and POLST/MOLST Forms

Attorney RJ Connelly III Certified Elder Law Attorney Professional Fiduciary

Thoughtful planning for health care decisions is among the most compassionate acts we can undertake for ourselves and our families. By proactively addressing these matters, individuals ensure that their medical preferences are respected and reduce the burden of uncertainty on loved ones during challenging times. This is why today's blog, Understanding Advance Directives, Health Care Proxies, and POLST/MOLST Forms is important reading.

"These items are not just legal documents—they are a voice for your values and wishes when you cannot speak for yourself," said professional fiduciary and certified elder law Attorney RJ Connelly III. "They play a critical role in preserving autonomy and dignity during periods of incapacity."

We examine the significance and practical applications of advance directives, health care proxies, and Medical Orders for Life-Sustaining Treatment (MOLST)/Physician Orders for Life-Sustaining Treatment (POLST) forms. Special attention is given to the unique legal frameworks and requirements in Rhode Island, Massachusetts, and Connecticut, ensuring residents of southern New England are equipped with state-specific knowledge. By understanding the mechanics and implications of these essential documents, individuals and families can make informed, empowered decisions that honor their values and promote peace of mind.

Advance Directives: Definition, Purpose, and Nationwide Overview

An advance directive is a legally binding document that outlines your specific preferences for medical treatment should you become unable to communicate or make decisions for yourself. These documents encompass living wills and the designation of a health care agent or proxy, empowering individuals to articulate their wishes regarding life-sustaining measures, pain management, and organ donation. Attorney Connelly emphasizes, “The advance directive is your voice when you cannot speak for yourself. It ensures your values and decisions are respected, regardless of the situation.”

Although each state has distinct legal requirements and terminology, the fundamental purpose of an advance directive remains consistent: safeguarding your autonomy and ensuring your health care choices are honored. Attorney Connelly further explains, “No matter where you live, completing an advance directive is one of the most important steps you can take to protect yourself and your loved ones.”

Advance directives are not solely for those facing chronic or terminal illnesses; anyone aged eighteen or older should strongly consider preparing one. As Attorney Connelly notes, “Emergencies can happen unexpectedly. Having advance directives in place provides clarity, reduces the emotional burden on families, and offers clear guidance to health care providers.” Nationally, these directives are recognized in every state, though the forms and terminology may vary. Typically, advance directives include instructions regarding life-sustaining treatments, pain control preferences, and decisions about organ donation, ensuring your medical care aligns with your personal wishes.

Health Care Proxies: Role, Selection, and Legal Aspects

A health care proxy—sometimes called a health care agent or surrogate—is a trusted individual authorized to make medical decisions on your behalf. Attorney Connelly advises, "Choose your proxy carefully; it should be someone who knows your values and can advocate for them under pressure." The proxy's responsibilities include discussing procedures, authorizing or declining treatments, and ensuring your wishes are followed.

The process of appointing a proxy varies by state but typically involves legal forms, witnesses, or notarization. For example, New York and Massachusetts require the use of specific state health care proxy forms and at least two adult witnesses to sign the document. In Florida, the designation must be in writing and signed in the presence of two witnesses, one of whom cannot be a spouse or blood relative. In contrast, states like California allow broader formatting of advance directives and may permit notarization rather than witnesses.

Attorney Connelly reminds clients, "The health care proxy is your advocate in the medical system. Their familiarity with your preferences is essential for effective representation." It’s important to note that while some states recognize out-of-state proxies or advance directives, others accept only documents drafted in accordance with their own requirements, so it’s wise to verify local rules before traveling or relocating."

State-Specific Details: Rhode Island, Massachusetts, and Connecticut

Advance directives and proxies operate within a legal framework unique to each state. Here’s a closer look at local requirements:

Rhode Island: Rhode Island law recognizes living wills and durable power of attorney for health care. To be valid, forms require two adult witnesses who are not the proxy. Attorney Connelly emphasizes, "Rhode Island's process is straightforward, but you must ensure all signatures are collected properly, or the document may be invalid."

Massachusetts: The Health Care Proxy form is central. It allows you to designate someone to make health decisions if you are unable to. Massachusetts does not have a statutory living will, but written wishes can be provided. The health care proxy form requires two witnesses, and the appointed proxy cannot serve as one. Attorney Connelly advises, "Keep an open dialogue with your proxy; Massachusetts leaves much decision-making up to the proxy's interpretation of your wishes."

Connecticut: Connecticut enables living wills, the appointment of a health care representative, and organ donation directives. The state's forms require two witnesses, at least one of whom must be unrelated and not entitled to any part of your estate. "Connecticut’s forms are comprehensive, but ensure you update your directive as your wishes evolve," Attorney Connelly counsels.

Advance Directives versus Living Wills

An advance directive is a comprehensive legal document that communicates an individual's preferences for future medical care should they lose the capacity to make or express decisions. As explained earlier, these documents serve as a guide for healthcare providers and loved ones, ensuring that medical choices align with the person's values and wishes even when they cannot speak for themselves.

A living will, by contrast, is a more focused type of advance directive that specifically addresses the individual's desires regarding end-of-life care. This document comes into effect only if the person is terminally ill, in a persistent vegetative state, or otherwise permanently unconscious, and is unable to communicate their wishes. In a living will, individuals can state whether they wish to receive or forgo life-sustaining treatments such as cardiopulmonary resuscitation (CPR), artificial nutrition and hydration, dialysis, or the use of ventilators. The living will provides clear guidance to healthcare professionals and family members, helping to prevent uncertainty or conflict during emotionally challenging times.

In summary, while all living wills fall under the umbrella of advance directives, not all advance directives are living wills. Advance directives encompass a variety of legal instructions, including living wills, healthcare proxies, and durable powers of attorney for healthcare, each serving different but complementary roles in ensuring that an individual's healthcare preferences are honored. These documents are vital tools for proactive medical planning, offering peace of mind to individuals and their families by outlining clear, legally recognized guidance for future medical care.

POLST/MOLST Forms

Advance care planning forms are critical tools that help patients communicate their medical treatment preferences, particularly when they may not be able to speak for themselves. Among these, the POLST and MOLST forms play prominent roles in ensuring that a patient’s wishes are honored across various healthcare settings.

The MOLST/POLST form should be posted in plain sight where medical professionals can easily see it

The Physician Orders for Life-Sustaining Treatment (POLST) form is a standardized medical order that documents a patient’s preferences regarding treatments such as resuscitation, intubation, and artificial nutrition. Unlike advance directives, which generally outline long-term goals and values, the POLST form translates these preferences into actionable medical orders that are valid across different healthcare environments. Its primary purpose is to ensure that seriously ill or frail patients receive the level of care they desire, whether that means full intervention or comfort-focused measures.

The POLST form is intended for patients with serious illnesses or those nearing the end of life, in which medical decisions are imminent, and preferences should be clearly documented. It is typically used when a patient’s prognosis is limited and detailed decisions about life-sustaining treatments are necessary. Common scenarios include hospital admissions, transitions to hospice or long-term care, and situations requiring emergency medical services. The form is completed collaboratively by healthcare professionals and the patient (or their surrogate), ensuring that medical orders reflect the patient’s current wishes.

The Medical Orders for Life-Sustaining Treatment (MOLST) form serves a similar function to POLST, documenting a patient's preferences for treatments such as CPR, ventilation, and feeding tubes. While the terms are sometimes used interchangeably, the MOLST form has been adopted in certain states as a region-specific version of the POLST paradigm. Both forms are medical orders, but the POLST model is increasingly recognized for its national standardization and portability.

Many states are transitioning from the MOLST to the POLST form to promote consistency and improve communication across state lines and healthcare systems. This includes Massachusetts, which is expecting to roll out the POLST model in 2027. The POLST model offers a unified framework, making it easier for healthcare providers to understand and honor patient wishes regardless of where care is delivered. This transition addresses confusion caused by varying form names and formats and supports nationwide adoption of best practices.

The POLST model offers several significant advantages. It provides clear, actionable medical orders that are immediately recognizable and enforceable in emergency situations. The standardized format reduces misunderstandings among healthcare teams and ensures that patient preferences are respected across settings. Additionally, the POLST process encourages in-depth conversations between patients, families, and providers, supporting informed decision-making and aligning care with individual values.

"I must stress something that is very important," states Attorney Connelly. "I have conducted numerous trainings with older adults and their families about advance directives and have observed that there is often significant confusion about the proper use of these forms. POLST and MOLST forms are for those with serious illnesses or advanced frailty. These forms must be completed through a direct, thoughtful discussion between the patient and a qualified healthcare professional to ensure that the medical orders truly represent the patient's current health status, values, and treatment preferences. It is crucial for healthy individuals to avoid using these forms, as they are meant to direct urgent medical care decisions only when a person's health is seriously compromised."

Advance Directives versus Health Care Power of Attorney

"Advance directives and a Health Care Power of Attorney (HCPA) are both essential legal instruments in healthcare planning, each serving unique and complementary functions," Attorney Connelly explained. "It is vital for individuals and their loved ones to understand these distinctions, as such knowledge empowers them to make informed and compassionate decisions about future healthcare needs."

An advance directive, as described earlier, is a written statement that outlines a person's preferences for medical treatment in situations where they may no longer be able to communicate their wishes. These documents typically include living wills, which specify the types of life-sustaining treatments an individual does or does not want, such as resuscitation, mechanical ventilation, or tube feeding.

In contrast, an HCPA designates a specific individual—known as a healthcare agent or proxy—to make medical decisions on the person's behalf if the person becomes incapacitated. Unlike advance directives, which provide instructions for specific scenarios, an HCPA grants broader decision-making authority, allowing the agent to respond to unforeseen medical circumstances that may not be covered in the advance directive. In essence, while advance directives express direct wishes about care, the HCPA appoints someone to interpret and advocate for those wishes, as well as make decisions in situations the directive does not address.

Both tools can be used together to ensure comprehensive healthcare planning. The advance directive provides clear guidance, while the HCPA ensures that someone trusted can communicate with healthcare providers and make decisions aligned with the person’s values and preferences. It is important to review and update both documents regularly to reflect any changes in personal wishes or circumstances.

The Importance of Advance Directives at an Emotional Time

Advance directives are essential tools for safeguarding families from internal conflict and emotional distress during medical crises. By allowing individuals to document their healthcare preferences—such as choices about life support, resuscitation, or pain management—in advance, these documents provide clear guidance when the person is unable to communicate. This explicit direction removes guesswork, minimizing the risk of disagreements among loved ones who might otherwise hold conflicting beliefs or expectations about treatment.

For example, siblings who interpret a parent’s wishes differently can avoid intense arguments, as the advance directive serves as an objective reference point. In addition, healthcare professionals are relieved of the burden of mediating family disputes, ensuring that care decisions align with the patient’s values. Ultimately, advance directives foster harmony, reduce long-term resentment, and support families in acting together with confidence and unity during challenging moments.

A Final Thought

Advance directives, proxies, and MOLST forms are vital instruments for conveying your health care wishes. Attorney Connelly urges, "Start the process before a crisis. The peace of mind you give your family is invaluable." For forms and further guidance, consult your state’s Department of Health or speak directly with an elder law attorney or medical provider. As Attorney Connelly reminds us, "Advance planning is a gift of clarity and comfort to those who care about you. It ensures your wishes are respected when it matters most."

The materials and information presented in this blog are intended solely for general informational purposes and should not be interpreted as legal, financial, or healthcare advice. The content may not reflect the latest developments, regulations, or best practices in these fields, and as such, should not be relied upon for making personal or professional decisions. This blog may include links to third-party websites provided strictly for the convenience of our readers; Connelly Law neither endorses nor guarantees the accuracy or reliability of external content. Case studies shared herein are anonymized, contain no identifying information, and may be amalgamated from multiple cases for illustrative purposes only. Given the complexities of legal, financial, and healthcare matters, we strongly recommend consulting a qualified attorney, a professional fiduciary advisor, or a healthcare provider for guidance tailored to your specific circumstances. Your well-being and ability to make informed decisions remain our utmost priority.