Durable Power of Attorney Example - Massachusetts

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8. The document will remain in effect until you revoke (cancel) it. You may revoke this
document (in whole or in part) or limit your health care agent’s authority at any time by
notifying your agent or health care provider orally or in writing, or by doing anything else
showing your intent to revoke. You will also revoke this document if you sign a new
document naming a health care agent or if you legally separate from or divorce your
spouse and your spouse is named as your health care agent in the document.
9. You and your agent generally have the right to require the doctor and private facility
providing treatment and care for you to honor your health care decisions. If a treating
doctor considers it against his or her moral or religious beliefs to do so, the doctor may
refuse to comply but must transfer your care to another doctor willing to do so. A private
facility can refuse to honor your decisions only if it has a formally adopted policy based
on religious beliefs, and it informs you or your agent before or upon admission, if that is
reasonably possible. It must also allow your transfer to a facility willing to comply. If the
doctor or facility and your agent are unable to arrange a transfer, judicial guidance must
be sought or your or your agent’s health care decision must be honored.
10. This type of document has been authorized by Mass. Ann. Laws Ch. 201D, §§ 1 17
(2011).
11. You should periodically review this document to be sure it complies with your wishes.
Before making any changes, be aware that it is possible that the statutes controlling this
document have changed since this form was prepared. Contact the Will to Live Project
by visiting www.nrlc.org (click on “Will to Live”) or an attorney to determine if this
form can still be used.
12. If you have any questions about this document or want assistance filling it out, please
consult an attorney.
For additional copies of the Will to Live, please visit www.nrlc.org
Form prepared 2001
Clerical changes made 01/09
Reviewed 2013
2 of 2
Page 5/9
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Durable Power of Attorney Example - Massachusetts PDF

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