By Edward H. Adamsky

            The Massachusetts courts have a procedure to deal with people with mental health issues for whom the medical professionals would like to prescribe anti-psychotic medications. Based on the 1983 case of Rogers v. Commissioner of Department of Mental Health, the system provides for a Guardianship proceeding. The Court may appoint a person with authority to consent to extraordinary medical procedures such as anti-psychotic medications to treat the mental health issues. The so-called Rogers proceeding uses the “substituted judgment” standard and requires yearly reviews at a minimum.

            Massachusetts also has a Health Care Proxy law that allows a person (while competent) to appoint a person who will have authority to make medical decisions for them when they are no longer competent. The two systems were in conflict for many years as it was not clear if you needed a Rogers proceeding if there was an appointed Health Care Agent who could make those decisions. The Massachusetts Chapter of the National Academy of Elder Law Attorneys sought an answer in 1997 and received a letter from the Attorney General of Massachusetts who stated that Health Care Agents can consent to treatment without a Rogers proceeding.

Some confusion still existed though, as civil commitment proceedings took place in District Court while Rogers Guardianship proceedings took place in Probate Court. The Probate Court often went through a careful analysis of the patient’s condition and the need for medications. The District Courts could order a civil commitment to a state hospital or other locked facility, along with administration of anti-psychotic medications, if it determined that a person was a danger to self or others.

The question still remained whether or not the Health Care Agent could make the medication decisions even if there was a civil commitment. In a recent case, the District Court determined a person required commitment to the hospital and ordered the administration of anti-psychotic medications. The person had a valid Health Care Proxy and the named Agent argued in Court that the Health Care Proxy superseded the commitment proceeding. This case went to a higher court level where the Appeals Court ruled that the civil commitment by the District Court was a valid exercise of the Court’s power, but that the Health Care Proxy was superior to the Court’s order of administration of medications. Thus, the Agent under the Health Care Proxy was the person who would make the final decision on medications and not the Court.

The Massachusetts Health Care Proxy statute protects the right of a patient to autonomy with regard to the administration of antipsychotic medication even after the patient has lost the capacity to make personal decisions. By executing a health care proxy, an individual can determine in advance that a competent person of the individual’s choice, rather than a judge or Court, will make such a decision on the individual’s behalf.