I have been hearing about a new kind of advance directive called MOLST. Can you explain what MOLST is and how it is different from other advance directives?
MOLST stands for Medical Orders for Life-Sustaining Treatment. Like other advance directives, it provides a means for individuals to state their wishes regarding medical treatment.
The MOLST takes effect once signed. It documents consent for a DNR or "do not resuscitate" order, whether one is in a hospital, at a skilled nursing facility or at home.
MOLST does not replace a health-care proxy or living will. Health-care proxies and living wills are two other advance directive forms that take effect only if the individual lacks capacity to make medical decisions for himself or herself.
How does MOLST affect me as a senior?
Not everyone needs to complete a MOLST. Healthy, active, independent adults of any age do not need a MOLST.
Seniors with increasing frailty and multiple health concerns, as well as individuals whose life expectancy may be a year or less, should consider a MOLST.
Health-care proxy agents for individuals who have dementia or lack the capacity to make their own medical decisions can also request it.
While everyone should have a health-care proxy, MOLST is intended for those who have a serious medical condition or chronic progressive disease.
It is also meant for anyone who chooses "natural death" and wishes for DNR, rather than cardiopulmonary resuscitation.
MOLST is further geared toward those who wish to limit medical interventions such as artificial nutrition, also known as tube feeding; mechanical ventilation; and antibiotics.
Some people want an intervention for a trial period to see if it would make a difference and help their health improve.
The MOLST form allows individuals to not only state the type of treatment they might want, but also the duration of time for receiving that treatment.
Do I need to fill in new paperwork for MOLST?
Yes, if you have not completed a MOLST in the past. The MOLST form is bright pink so that it can be easily identified by emergency personnel. It is a medical order and therefore needs to be signed by a licensed physician.
What if I go to Florida for the winter or decide to move out of the state?
Currently, MOLST or some other form of physician orders for life-sustaining treatment is available in only a handful of states.
But because MOLST is intended to be reviewed regularly and because it provides direction for your goals of care, it is important that you share the form with your medical provider wherever you are located.
Where can I find more information about MOLST and other advance directives?
Many resources are available on the Internet simply by searching for "advance directives," "health care proxy" or "MOLST."
The state Department of Health, Bassett Healthcare and Excellus' Compassion and Support are among the agencies that provide information.
In addition, you can ask your primary care provider for information. Attorneys can assist with proxies, living wills and power of attorney forms. At Bassett, you may also call the Pastoral Care Services office at 547-3626.
Why are advance directives important?
Advance directives are not cast in stone. Your wishes and goals for care may change depending upon your health. An advance directive, including a MOLST, can always be changed or revoked.
Many people, as they grow older, state that they do not want to be a burden to their families.
Having frank and open conversations with loved ones about goals for life, hopes for yourself and others, medical care and how you want to die and be remembered can be the greatest gift you offer your family. Research shows that such conversations help build hope and resiliency in times of grief.
Having a health-care proxy and, if appropriate, a MOLST, can lessen the burden your loved ones might feel if they are ever asked to make medical decisions on your behalf.
Rev. Betsy Jay is chaplain at Bassett Healthcare.