Suppose your 89-year-old mother, who suffers from congestive heart disease, lives in a nursing home and falls one afternoon in the bathroom. The medical team determines that she may have a broken hip, notifies you and sends her in an ambulance to the nearest ER.
In transit, she begins to experience chest pains and goes into cardiac arrest. She has made it clear to you, her health proxy, and in signed advanced directives that she does not want to be resuscitated (DNR) if her heart stops, for whatever reason. This information is on file in her medical chart at the nursing home. But the EMTs proceed to administer CPR, anyway.
When you arrive at the hospital, you learn that they restarted her heart, but she is in a very weakened state, barely able to communicate. You are confused, terrified for her and furious that the EMTs proceeded against your mother’s clear wishes.
Medical Orders Apply Only to a Specific Location
Did the EMTs do the right thing, even though they ignored your mother’s DNR order? The answer, surprisingly, is yes. In Massachusetts, medical orders only apply for the location where they are signed—in this case, only while your mother is at the nursing home (unless a separate set of Comfort Care orders were signed). She—or you, as her Health Care Proxy if she is unable—would need to consent to new medical orders for her hospital stay. So the EMTs did their job of trying to save your mother’s life, because that is what they are trained to do.
Convoluted? Yes. Well-intended to ensure proper care but impractical when applied to real life situations? Yes. Fortunately, however, there is now a way in Massachusetts to be certain that medical orders follow you or your loved one, wherever you go.
MOLST is a Portable Medical Order that Applies Anywhere
Medical Orders for Life-Sustaining Treatment, or MOLST, is a signed medical order that enables a patient with a current serious illness or injury and his or her health care provider to define what treatments that individual does and does not want in a life-threatening emergency—with a document that remains in effect wherever the patient is at that point in time, including a care facility, an ambulance or a hospital.
The bright fuscia form—hard to miss in a medical chart—specifies several options for treatment:
- Whether or not to resuscitate if the patient goes into cardiac or respiratory arrest
- Whether or not to intubate or ventilate if the patient is in respiratory distress
- Whether or not to transfer to a hospital (unless needed for comfort)
The MOLST form also specifies treatment choices for how respiratory support should be administered, whether and how the patient wants dialysis treatment, and whether and how the patient wants artificial nutrition or artificial hydration.
A Conversation Between Patient and Medical Professional is Key
Both the patient (or Health Care Proxy) and his or her physician, nurse practitioner or physician assistant must sign the order. This is a crucial step, because to get the most out of MOLST, patient and medical professional need to have a thorough conversation about all of these options, pros and cons, for the individual to make an informed decision.
Under current law, a legal guardian cannot sign a MOLST without specific authority by the court.
It’s important to note, as mentioned above, that the MOLST can only be used by a person of any age “with a current serious illness or injury from which they might not recover.” It is a portable medical order that does not take the place of a Health Care Proxy, which is a legal document that states advanced directives and appoints a health care agent who is authorized to make medical decisions for the patient if he or she is deemed medically unable to do so.
To learn more about Medical Orders for Life-Sustaining Treatment, visit www.molst-ma.org.
President of Deborah Fins Associates, PC, since 1995, Deborah Liss Fins is a licensed independent clinical social worker and certified geriatric care manager. Drawing on more than 30 years of professional experience in geriatric care management, DFA offers comprehensive assessments and planning, guidance in selecting appropriate care, help identifying resources for financial support and professional consulting. Please contact us to set up a complimentary initial telephone consultation.
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