Every time you go to a medical facility someone will ask you if you have an advance directive. Advance Directives can be several different forms:
- Health Care Proxy: This form designates other people to make a medical decision for you if you are ever unable to make them for yourself.
- Living Will: This document identifies your wishes should you ever be critically ill.
- DNR (Do Not Resuscitate): This document is used for those who have decided that in the event their breathing or heart stops, they would not like heroic measures to be performed to attempt to restart their lungs or heart.
- Medical Orders for Life-Sustaining Treatment (MOLST): This document is the least known. Detailed information follows:
What is MOLST?
Honoring patient preferences is a critical element in providing quality end-of-life care. MOLST is a program designed to improve the quality of care patients receive at the end of life by translating patient goals for care and preferences into medical orders. MOLST is based on communication between the patient, his or her health care agent or other designated surrogate decision-maker, and health care professionals that ensures shared, informed medical decision-making.
What is the DOH-5003 MOLST form?
To help physicians and other health care providers discuss and convey a patient's wishes regarding cardiopulmonary resuscitation (CPR) and other life-sustaining treatment, the Department of Health has approved a physician order form DOH-5003 MOLST, which can be used statewide by health care practitioners and facilities.
The MOLST form is a bright pink medical order form signed by a New York State licensed physician or a border state physician that tells others the patient’s medical orders for life-sustaining treatment. All health care professionals must follow these medical orders as the patient moves from one location to another, unless a physician examines the patient, reviews the orders, and changes them.
The MOLST serves as a single document that contains a patient’s goals and preferences regarding:
- Resuscitation instructions when the patient has no pulse and/or is not breathing
- Instructions for intubation and mechanical ventilation when the patient has a pulse and the patient is breathing
- Treatment guidelines
- Future hospitalization and transfer
- Artificially administered fluids and nutrition
- Other instructions about treatments not listed.
Under state law, the MOLST form is the only authorized form in New York State for documenting both non-hospital DNR and Do Not Intubate (DNI) orders. In addition, the form is beneficial to patients and providers as it provides specific medical orders and is recognized and used in a variety of health care settings.
What is the difference between a Health Care Proxy or Living Will and the MOLST form?
A health care proxy and a living will are traditional advance directives for adults 18 years of age and older. These documents are completed when a patient has capacity to do so and only apply when medical decision-making capacity is lost.
To complement the use of traditional advance directives and facilitate the communication of medical orders impacting end-of-life care for patients with advanced chronic or serious illness, the MOLST program was created. It contains specific and actionable medical orders that transition with the patient across health care settings. Health care proxies and living wills typically contain more general instructions, and cannot be followed by EMS providers in an emergency.
In contrast to a health care proxy, the MOLST applies as soon as a patient consents to the orders in it and a physician signs it. It is not conditional on a physician’s determination that a patient has lost medical decision-making capacity. The MOLST program is based on the belief that patients have the right to make their own health care decisions, including decisions about life-sustaining treatment, to describe these wishes to health care providers and to receive comfort care while wishes are being honored.
What type of adult patient should have a MOLST form?
MOLST is generally for patients with serious health conditions. Physicians should consider consulting with the patient about completing a MOLST form if the patient:
- Wants to avoid or receive life-sustaining treatment.
- Resides in a long-term care facility or requires long-term care services.
- May pass away within the next year.
Patients with serious health conditions typically include those who have advanced chronic progressive illness and/or frailty (significant weakness and extreme difficulty with personal care activities) and those who may die or lose medical decision-making capacity in the next year. MOLST also may be appropriate for a patient with advanced age wishing to further define his or her preferences for care.
These patients may:
- Want all appropriate treatment, CPR.
- Want to avoid all life-sustaining treatment.
- Choose to limit life-sustaining treatment.
- Want to avoid any attempt to initiate CPR and prefer to Allow Natural Death (DNR order)
- Want to avoid placement of a tube down the throat into the windpipe connected to a breathing machine (intubation) and request a DNI order.
Does the MOLST form replace traditional Advance Directives?
No. A properly completed MOLST form contains legal and valid medical orders. It is not intended to replace traditional advance directives like the health care proxy and living will.
For more information about planning for a serious illness, please talk with your healthcare provider.