A Medical Orders for Life Sustaining Treatment or, more simply, a 'MOLST' Form is a portable medical order form that must be honored by emergency medical personnel in an emergency and all health care professionals in all settings. As you read on I will talk more specifically about what the MOLST form contains, why it is so very important and who would be a good candidate to have one.
Before I go in depth about MOLST forms I want to briefly touch on 2 other kinds of advanced directives that you may already be familiar with:
A 'Do Not Resuscitate' or DNR order is a signed order that covers only chest compressions and intubation (breathing tube) in the case of a medical emergency, and if one is presented at that time it must be honored.
A Living Will is a legal document that is drafted by a lawyer and puts into writing what a person's wishes are should they become medically fragile or incapacitated. It is a valuable way to communicate to family or medical decision makers (often times Health Care Proxy) what you would and would not want done with respect to end of life care decisions. However a living will must meet state requirements, be notarized and even so may not be enforceable in an emergency situation, and can often times be overridden by family members/decision makers.
Both of these advanced directives are important and are appropriate for anyone regardless if they are healthy or not. They help to clear up confusion and make your wishes clear in a time that can be wrought with grief and indecision.
So why consider a MOLST? A MOLST is an additional type of advanced directive that is more appropriate for people who are nearing the end of their life or who have a chronic condition that can be considered, in time, a fatal process (please see the list provided in the first link below). A MOLST form, along with a medical provider, guides patients and their families to make informed, educated and specific decisions about their care. In doing so it also helps avoid tricky legal and ethical situations such as a feeding tube being placed in a patient who stated they did not want one, siblings or co-health care proxy's disagreeing about the course of treatment or the inappropriate override of a patient's wishes in order to extend their life for financial gain, all of which I have unfortunately witnessed.
A MOLST covers a range of topics including transfer to a hospital from home or a care facility, resuscitation, organ donation, the use of artificial food/fluids (IV or Feeding tube) & treatment guidelines (comfort measures). Each are addressed individually and may be tailored to a patient's wants and needs at that time as it is specific to the current status. The form may also be updated as needed.
While Advanced Directives may not be the most glamorous or joyful topic I felt the need to address them so that I can personally convey to you just how very important they are both for patients and their caregivers (who are often times family members/children), who in times of distress may not be willing or able to act out the patient's wishes, particularly if those wishes had never even been discussed.
Let's take the fear and stigma out of Advanced Directives. They should not be seen as ghoulish or frightening but rather as peaceful. Peaceful for the patients knowing that they are in control of their own care, and peaceful for loved ones to be relieved of the burden of the unknown.
If you have any questions please know that myself and my staff are always available to address any of your questions or concerns. Additionally I am including several links that expand further on MOLST forms as well as the Official NYS MOLST so that you can read it over for yourself.
Sheryl Pearl, MD
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