A new model for end-of-life care issues, called MOLST, is now in use in Massachusetts. Around the nation, and in New Hampshire where it is also being used, the system is called Physician’s Orders for Life Sustaining Treatment (or POLST). In Massachusetts the first word is changed to “Medical” thus giving us MOLST. The point of the system is to provide a method for patients and doctors to communicate the patient’s wishes for end of life care in various ways and across all medical facilities. It is sort of an expanded Do Not Resuscitate Order (DNR) that can provide for quality of life decisions in advance.
The MOLST is a two page standardized form containing valid medical orders based on a patient’s own preferences and goals of care. It is authorized by the Massachusetts Department of Health and Human Services and EMT’s are required to honor valid MOLST forms under the Office of Emergency Medical Services protocol. It is not designed for healthy individuals and is more suitable for patients with an advance illness including chronic progressive diseases, life threatening conditions and advanced dementia. It is usually suitable for anyone for whom a DNR would be suitable.
A MOLST form can be signed by a physician, nurse practitioner or physician assistant. It is also signed by the patient or the patient’s valid Agent under a Health Care Proxy. The first page contains choices for Cardiopulmonary Resuscitation, Ventilation, and Transfer to a Hospital. The second page has options for intubation, dialysis, and artificial nutrition and hydration (feeding tubes and IV fluids). All of the sections on each page should be completed on the form and all hand-writing should be clearly legible, but each of the two pages of the form can be valid independent of the other page – that means you can skip some parts of the form if you like.
The signed form is kept with the patient and moves with the patient to new facilities. Thus the orders can be followed in the hospital, at home, and in a new facility. Patients are instructed to keep the MOLST form handy and a copy should be placed in the medical record at any facility where the patient gets services regularly. Copies are just as valid as the original.
Using the MOLST form is voluntary and it can be revoked at any time. An Agent under a Health Care Proxy can also revoke a MOLST. You should, if you have a serious medical condition, discuss the use of a MOLST or POLST with your doctor or medical provider. You should have a Health Care Proxy already, but if not, discuss this with your Elder Law Attorney.