Many individuals who are interested in advance health care planning--and that should be just about everybody--are familiar with the Health Care Proxy and the Living Will. Relatively few were aware of another document called Medical Orders for Life Sustaining Treatment (MOLST). Until recently.
On July 7, 2008, Governor David A. Paterson signed Chapter 197 of the Laws of 2008, amending New York Public Health Law, § 2977 which allowed the MOLST form to be used statewide in lieu of the NYS Non-Hospital Do Not Resuscitate (DNR) form. Prior to that date, MOLST was legally approved for use in hospitals and nursing homes across New York State. A pilot program allowed its use as a Non-Hospital DNR only in Monroe and Onondaga counties.
What is the difference between a Health Care Proxy or a Living Will and the MOLST?
The foremost difference is that it is a medical order. A Health Care Proxy and a Living Will are documents created by patients to cover a gamut of possible medical treatments. Their effectiveness in non-medical settings is extremely limited. Emergency medical services were allowed only to follow a DNR which was limited to situations involving cardiac or respiratory arrest.
The MOLST form is also completed by a patient but it is reviewed by and with the patient's physician. The objective is to express the patient's treatment goals as medical orders that can be acted on without doubt or confusion. It is based on the patient's right to informed consent and to withhold consent. The order is signed by the physician and reviewed periodically.
The bright pink MOLST form is sent with the patient upon transfer or discharge.
The MOLST is recommended for people with serious or advancing chronic illness and those who want to further define their care wishes by limiting medical interventions or clarifying a request for all medically indicated treatments including resuscitation and intubation. In this regard, it may seem like nothing more than a detailed DNR.
The message behind a DNR is often viewed as a negative one, however. It suggests to many an absence of treatment and care. The MOLST ensures that comfort care and palliative care, which
are appropriate interventions for those with chronic illness or end stage illness, are provided.
For more information about MOLST, visit www.health.state.ny.us
