Health Care Proxy in 8 Languages
Every competent adult, 18 years old and older, can exercise his or her right to choose a Health Care Agent in a Health Care Proxy. We have translated the Honoring Choices Health Care Proxy Instructions & Form into 8 languages. Click on the language below to view and print a document.
Instructions for English Speaking and Bi-lingual Adults
Each of the 8 translated documents contains a translated Instructions page, a translated Health Care Proxy form, and a Health Care Proxy form in English. The Instructions page will direct adults to fill out the translated Health Care Proxy first, and then if possible, to fill out the Health Care Proxy form in English with the same information and the same date. Having a Health Care Proxy in English will help English-only speaking doctors and care providers understand and honor your choices. Just follow the instructions below to complete a Health Care Proxy.
Whether you are filling out this document for yourself or helping another adult with this process, here are 3 simple steps to follow:
1. Choose an Agent.
Choose a trusted person to make health care decisions on your behalf when you are not able to make or communicate decisions yourself. Select a language above and print the entire document, between 3 and 5 pages depending on the language. Each document contains the translated Instructions page, a translated Health Care Proxy form, and the Health Care Proxy form in English. For more information on choosing an Agent, click here.
2. Appoint Your Agent.
Read the Instructions page and fill out the translated Health Care Proxy. Then if possible, fill out the Health Care Proxy in English at the same time with the same information and the same date. You will need two adults to witness your signature and date, and sign after you do, first on the translated form and then again on the English form. Witnesses can be any competent adult except your Agent and Alternate Agent. Keep the original documents and give a copy of your Health Care Proxy to your Health Care Agent and Alternate Agent.
3. Give a Copy To Your Doctors To Place in Your Medical Record.
Give a copy of your Health Care Proxy to your doctors and care providers to place in your medical record so they always know how to contact your Health Care Agent.
“The Massachusetts State legislature made it very clear that the goal of language access is to provide the broadest possible protection for the rights of non-English speaking persons to understand and be understood”, says Erika J. Rickard, Esq., Access To Justice Coordinator, Massachusetts Trial Court. In her interview, Ms. Rickard shares the court’s framework for language access services for non-English speaking individuals to help ensure equal and meaningful access to justice. We learn about available services such as multi-language interpreter services and translated court documents. We see how the court’s framework to provide linguistically appropriate information and documents extends into health care to help consumers understand and make informed choices. Click here to read this informative interview.
MOLST: Translated Information & Sample Form
MOLST, or Medical Orders for Life-Sustaining Treatment, is a medical order that documents decisions about life-sustaining treatments made by patients with serious advancing illness. The MOLST form is filled out by the patient and a clinician after they have talked about the patient’s medical condition, and the patient has made decisions about the use of life-sustaining treatments. The patient’s decisions are documented in the MOLST form to be honored by all clinicians in any treatment setting.
The MOLST website has downloadable educational materials, brochures, and a sample MOLST form translated into Spanish, Portuguese, Vietnamese, Chinese, Arabic, Khmer, Haitian Creole, Russian and Cape Verdean. The educational materials and sample forms are for informational purposes only. Since MOLST is a medical order the MOLST form must be filled out and signed by the patient and clinician on the English language form to be valid. Click here to read more about the MOLST Translated Educational Information.
Translated Guide for Adults with Serious Advancing Illness
“In Massachusetts, all patients with serious advancing illness have a legal right to receive information about their medical conditions, their likely outcome (“prognosis”), and their full range of options for care”, says the Department of Public Health’s Know Your Choices: A Guide for Patients with Serious Advancing Illness. The guide includes information on advance care planning, the MOLST form, Palliative Care and Hospice Care, which “enables patients or their advocates to make informed decisions about healthcare choices that reflect each person’s goals, values, wishes, and needs.” The Know Your Choices guide is translated into Spanish, Portuguese, Vietnamese, Chinese, Arabic, Khmer, Haitian-Creole, Russian and Cape Verdean. Click here to read more and view the translated guides.
Read more about the state regulations that require all licensed hospitals, clinics, and long-term care facilities to distribute information that is linguistically and culturally appropriate on a full range of options to adults with serious advancing illness.