Often, when discussing living wills or health care proxies, clients express their desire for more expansive descriptions of the treatments they want, or do not want, at the end of their lives. While that level of detail is often inappropriate in a health care directive, there are ways to provide your medical providers with a broader view of your wishes. This article discusses one such mechanism that clients can utilize.
In Connecticut, Medical Orders for Life Sustaining Treatment (“MOLST”) are voluntary planning tools that patients may use in conjunction with a health care directive or living will. These orders may be appropriate for patients who are at the end stage of a life limiting illness or in a condition of advanced progressive frailty.
MOLST allow patients the opportunity to make important decisions and express their wishes with respect to medical care and treatments, such as cardiopulmonary resuscitation (CPR), hospitalization, intubation/ventilation, and dialysis. In order to be valid, the orders must be: (i) Filled out by a physician, advanced practice registered nurse, or physician assistant; and (ii) On a specific form approved by the Connecticut Department of Health. Before executing the form, patients should discuss their medical condition, preferences, and goals with their health care providers; providers should educate patients, but never influence any of their decisions.
The MOLST form differs from advance care directives in significant ways and should not be used as a replacement for a health care proxy or living will. Advance directives are legal documents that take effect once the signer loses capacity, whereas the MOLST form is a medical document that is effective immediately. In addition, it is recommended that anyone over the age of 18 have advance directives in place, while MOLST are only appropriate for patients near the end of life. The MOLST form strictly expresses the patient’s wishes regarding medical care and can complement or reinforce the patient’s advance care directives.
The patient should always keep the completed MOLST form with them; it is especially important to bring it to medical appointments and admissions to health care facilities. Upon transfer to a new hospital or facility, the form should be reviewed to ensure the patient’s health condition or treatment preferences have not changed. If there are changes, the form must be voided and a new one completed. At any time, the patient can revoke the form and request medical treatment that the patient previously refused.
If you have any questions about the MOLST form or would like to discuss how it would integrate into your estate plan, please feel free to contact me or one of the other estate planning attorneys at Bayer & Black, P.C.