What is a MOLST form? Do I need it? Planning for end-of-life...

MOLST stands for “Medical Orders for Life­Sustaining Treatment”. 

It is a form filled out by a physician and it contains actual orders in regards to important end-of-life issues. Other health care professionals in different settings must follow these orders.

The Department of Health New York really promotes its use. It is recommended for persons with a serious illness or anybody who lives in a long­term care facility or requires long­term care services.

This form covers important topics that are relevant at the end of life. Here are these topics:

Pink Original MOLST form

• Resuscitation

• Framework for Treatment Guidelines: 

1. Comfort care
2. Limited medical interventions
3. No limitations on medical interventions

• Instructions on the use of breathing machines (intubation)

• Future Hospitalizations

• Use of artificial iv hydration and nutrition

• Antibiotic use

• Other instructions

The orders may entirely focus on avoiding any aggressive measures and making sure that the patient’s wishes of comfort care, no resuscitation, no use of antibiotics ne honored.

It is also possible to tailor these orders to an individual’s beliefs and values. Somebody may not want to be on breathing machines but they might still want workup for some of their symptoms (e.g. a CXR) and treatment with antibiotics.

A wonderful aspect of these orders is that they provide the option of “no hospitalization”. There are many people who would very much prefer not to go to the hospital and to stay in the home setting; event if it meant they’d die at home. (Of course, most of those should probably be on hospice – more about that in a future blog post)

By the way, the original MOLST form (in NY it is pink) always stays and travels with the patient from nursing home to hospital to rehab back to nursing home. The doctors and institutions keep copies only.

Not all states are using the MOLST form, some states even call it the POLST form. Talk to your doctor about what options you have. I would strongly encourage you to look into this.

Check out the MOLST form for New York State: Department of Health Website MOLST.

And remember, nothing is written in stone. You will always have the right to change your mind. Your doctor should periodically check in with you about your wishes to make sure that your MOLST is still up to date (there is a section the physician may sign).

This all may seem very scary but it shouldn’t be.

Planning for your future health care today ensures that you are able to voice all your concerns and make your own choices.

I wish you all the best for this endeavor,

Dr. B

PS: Check this article by elder lawyer Nancy Burner for more info on the MOLST form.

What is the most important document I need as a patient?

This is a very easy question.
Even though, there are many things that may be important, there is one that trumps them all:

The health care proxy!

Why is that?

The health care proxy is a person that you trust to speak with the doctors on your behalf when you are unable to do that yourself.

You might still be fit and very healthy and may think that you won’t need a Health Care Proxy any time soon – but beware!

What if you lose consciousness and cannot respond? You might recover from this, however, someone should be there assisting the doctors in making the right decisions.

What are the “right” decisions? 

These are things that you would decided the same way yourself.
It may not be what most people would choose for themselves but it is what YOU would want and that’s what makes it the “right” decision.

This is why it is crucial for you to be in constant communication with your health care proxy. This is the person who should know all your wishes and should have enough information about you to be able to guess what you would say in any given scenario.

Who can be a health care proxy? Does it have to be a relative?

Anyone above the age of 18 years can be your health care proxy.
You don’t have to be related.
Make sure to speak to this person about this, though.

He or she should be aware of this assignment and they should be willing to take on this important responsibility.

How to get started?

There is no easy way to talk about serious illness, disability and death.
Speak to your doctor about this if you have any further questions or require support or assistance. 

Also, check out this website: the conversation project 
There you will find a lot of resources on how to have these kinds of conversations.
They even offer a “starter kit” to help you jumpstart the conversation: Starter Kit.

By the way, you do not need a lawyer to fill out a health care proxy form (at least not in New York State). Ask your doctor about details as they might be different in the various States.

In New York State you would only have to fill out the form which you can find on the Department of Health Website: Health Care Proxy Form NY. You will need to have two adult witnesses to sign with you.

When you express yourself and you know that people are listening and willing to follow your wishes then you will have peace of mind. Also, you are relieving your loved ones from the burden and guilt. 

When they know your wishes they can be comforted by the assurance that the difficult decisions were yours not theirs. It is a gift you give to them as well as to yourself.

If you don’t already have a Health Care Proxy, make it a goal to sign one this month!

Be well,

Dr. B