Question: My mother has been diagnosed with a terminal illness and has specific wishes with regard to end of life decisions. She executed a living will and a DNR during her last hospital stay; however, she is concerned that her wishes may not be followed. Is there any other document that would ensure her wishes are carried out?
Answer: In addition to traditional healthcare advance directives, such as a Healthcare Proxy and Living Will, the MOLST form is another advanced directive one can execute to ensure their end-of-life wishes are followed.
MOLST stands for “Medical Orders for Life-Sustaining Treatment.” It was originally tested in Onondaga and Monroe Counties in May 2006. In July 2008, after a successful pilot program, the MOLST program was implemented on a permanent, statewide basis. The Department of Health updated the form in June of 2010 to make it more user-friendly and to make it compliant with the Family Health Care Decisions Act. Despite the fact that the MOLST form has been around for several years, many people are unaware of its existence. In fact, even many physicians and social workers are not familiar with it.
Unlike a Living Will which can be prepared well before the end of your life, the MOLST form is a medical document traditionally executed when the patient wants to avoid or receive any or all life-sustaining treatment, is in a long-term care facility or requires long- term care services and/or may die within the next year. It is intended to assist health care professionals in discussing and developing treatment plans that reflect the patient’s wishes. The program is based on the idea that communication between you as a patient (or your legal surrogate) and your health care providers will result in informed medical decision- making. A licensed physician must verify that the treatment plan accurately represents the patient’s wishes in light of their prognosis and sign the form. Once executed, all health care professionals must follow the orders designated by the patient from one location to another, unless a physician examines the patient, reviews the orders and changes them.
The MOLST form itself is four pages long and bright pink to ensure that it can be found easily in an emergency. It documents medical orders regarding life-sustaining treatments such as Cardiopulmonary Resuscitation (CPR), intubation, mechanical ventilation, artificial hydration and nutrition. The form can be used to limit medical interventions like cardiopulmonary resuscitation (CPR) or to clarify a request for specific treatments. Through this document, you can include directions about other types of medical procedures that you may or may not want to receive. Moreover, because the form is intended to follow the patient, it is used and recognized in a variety of health care settings.