Do you have a MOLST? Do you know if you should?
MOLST stands for Medical Orders for Life-Sustaining Treatment. A MOLST is a standardized document that translates a patient’s preferences for certain life-sustaining medical treatments into an actual medical order. The medical order is effectively immediately, as soon as the doctor and patient sign the MOLST. It must be followed just like any other medical order. You can change your MOLST at any time. You can change the treatment you want even if it contradicts what you noted in your MOLST. While you should consult your physician about your specific situation, a MOLST is generally best suited for someone with a serious advanced illness or if the illness is such that the patient is discussing Do Not Resuscitate orders with his or her doctor.
So how is a MOLST different than a health care proxy or advance directive? Your health care proxy and advance directive become effective if you lose capacity. In this situation, you are considered to have lost capacity if you unable to understand or communicate your decisions concerning your health care. For example, if you are unconscious. An attorney drafts them, and they are legal documents. If you are able to discuss your medical care, then neither of those documents is activated. A MOLST is discussed and signed when you are able to discuss your health issues and can sign the form yourself. You should discuss a MOLST with your doctor, not your attorney, because it involves clinical decisions that become medical orders effective immediately. A MOLST is therefore not a substitute for a health care proxy or an advance directive. If you have a MOLST and you are incapacitated, your health care proxy can make decisions for you and those decisions take precedence over your MOLST. This is just one of the reasons I encourage my clients to choose a person they can trust as their proxy. You should have a proxy who knows your wishes concerning medical care, and who you know will make those wishes known to medical personnel if you can’t.
A person should keep a MOLST in a place where it is easy to locate and should carry it on her when she leaves her home. Her primary care provider should also have a copy. I suggest you keep a copy with your estate planning documents as well.
You should talk with your doctor to decide if you need a MOLST. To learn more about MOLST, visit Massachusetts Medical Orders for Life-Sustaining Treatment and talk with your medical care provider to see if one is right for you. Contact me today if you need a health care proxy, advance directive, and other incapacity documents.