Estate planning conversations usually start with who gets the house. The harder documents, and often the more important ones, deal with a different question: who decides about your medical care when you cannot, and what should they decide? Three documents live in this space, they are constantly confused with each other, and the differences matter at exactly the moment nobody can ask you to clarify.
What is the health care proxy? Naming a decider
A health care proxy (called a health care power of attorney or the appointment of a health care representative in other states, including Connecticut) does one thing: it names a person, your agent, to make medical decisions for you if a physician determines you lack the capacity to make them yourself. It does not need to predict your medical future. It transfers the decision to someone you trust, who can react to facts as they actually unfold.
That flexibility is why lawyers tend to treat the proxy as the essential document. In Massachusetts, the proxy statute is the backbone of the system, and this is a genuine quirk: Massachusetts is one of the few states with no statute giving binding effect to a living will. A Massachusetts living will is evidence of your wishes, and your agent and doctors should consider it, but the legally operative act is the proxy appointment. Connecticut, by contrast, gives statutory recognition to both the appointed representative and written health care instructions. The constitutional floor underneath all of this is the Supreme Court’s recognition, in Cruzan v. Director, Missouri Department of Health, 497 U.S. 261 (1990), that competent individuals have a protected interest in refusing unwanted medical treatment, with states allowed to set evidentiary rules for honoring that interest once capacity is gone.
What is the living will? Instructions in advance
A living will is a written statement of what treatment you would or would not want in defined circumstances, typically terminal illness or permanent unconsciousness: ventilation, artificial nutrition and hydration, resuscitation. Its strength is that it preserves your own voice. Its weakness is that it is written before the facts exist, in language that may not map onto the actual clinical situation, which is why it works best paired with a proxy rather than instead of one. The living will guides the agent; the agent handles everything the document did not anticipate, which is usually most things.
What is MOLST? Medical orders, not planning documents
The third document is different in kind. A MOLST form (Medical Orders for Life-Sustaining Treatment; other states use the name POLST) is not something you draft with a lawyer. It is a set of actual medical orders, signed by you or your representative together with a physician or other authorized clinician, translating your treatment preferences into instructions that emergency personnel and facilities follow: attempt resuscitation or not, transfer to hospital or not, intubate or not. Both Massachusetts and Connecticut operate MOLST programs.
The distinction matters practically. A living will is a planning document for a hypothetical future and generally cannot bind an EMT. A MOLST form is a standing medical order for a patient who is already seriously ill, designed for the near term and portable across care settings. The usual guidance is that advance directives are for every adult, while MOLST belongs in the picture when a clinician would not be surprised by the patient dying within a year or so.
How do the pieces fit together?
A complete set looks like this: a health care proxy naming an agent and a backup, a written statement of wishes to guide that agent, and, late in a serious illness, a MOLST completed with the treating clinician. Alongside them sits the durable power of attorney for finances, a separate instrument from the medical proxy, because the person managing your medical decisions and the person paying your bills are appointed by different documents even when they are the same human being.
None of these documents require a crisis to prepare, and all of them are cheaper, in every sense, than the court process that becomes necessary when they do not exist.
I am a law student, not a lawyer. Nothing here is legal advice.
