Many people are aware of Living Wills and Advance Directives, legal documents that allow people to make an advance determination about end of life care should they be unable to make a decision or communicate with their doctors.
Now, under Maryland Law, there is another document to direct health care providers with instructions as to one’s care alternatives, including end of life treatment: the Maryland Order for Life Sustaining Treatment form, more commonly referred to as the MOLST form. The MOLST form is a doctor’s order concerning what actions to take with respect to life sustaining treatment.
Most people admitted to a hospital or nursing home, and some other health care facilities, will be confronted with the fact that a MOLST form will be completed for them. The purpose of the MOLST form completion process is to facilitate informed consent, and there should be an appropriate physician-patient discussion (or in some instances physician-health care agent discussion) concerning what actions to take in particular circumstances.
Unfortunately, many people find that they are given a MOLST worksheet to fill out and on which to make particular choices without the opportunity to have a proper informed consent discussion. Once that worksheet is turned in to the health care provider, a MOLST is prepared and signed by a doctor.
This is a dangerous situation. Many people, familiar for years with the purpose of a medical advance directive know that they can state in advance their wish not to be resuscitated and kept alive only in the most dire end-of-life situations. With that in mind, a patient presented with a MOLST questionnaire, without an appropriate informed consent discussion, may think that they are completing an advance directive, choosing not to be resuscitated, thinking that such choice will apply only in those extreme situations (such as when death from a terminal condition is imminent).
If one were to answer a questionnaire in this manner, then they might end up with an active MOLST, which is a doctor’s order, ordering that the patient is not to be resuscitated if cardiac arrest occurs, even for a routine surgery for a non-life threatening injury for which the patient would undergo general anesthesia.
This is a very real problem. It is important that individuals know their rights, have appropriate estate planning documents, including an advance medical directive that states their wishes, and understand that they should never complete a MOLST worksheet without proper physician or other health care provider guidance in the context of a substantive informed consent discussion upon admission to a health care facility.