You may have heard about a new kind of health care directive, called a Delaware Medical Orders for Scope of Treatment (DMOST) form. This form can help critically ill patients document their end-of-life health care wishes. It replaces a similar form that Delaware used in the past, called a Medical Orders for Scope of Treatment (MOLST) form.
A DMOST form is a doctor’s order that helps you keep control over medical care at the end of life. Like a Do Not Resuscitate (DNR) order, the form tells emergency medical personnel and other health care providers whether or not to administer cardiopulmonary resuscitation (CPR) in the event of a medical emergency. A DMOST form may be used in addition to -- or instead of -- a DNR order. The DMOST form may also provide other information about your wishes for end-of-life health care.
A DMOST form must be signed by a doctor, advance practice registered nurse, or physician's assistant. A health care professional can help you create a DMOST form if you enter a medical facility or health care setting -- such as a hospital, nursing home, or hospice care in a facility or at home. If a member of the medical staff does not ask you whether you want to create a DMOST form, you may ask for one.
In addition to the health care professional's signature, you or your legally appointed health care decisionmaker must sign the DMOST form.
A DMOST form is usually printed on brightly colored paper so it will easily stand out in your medical records. The form travels with you if you move from one health care setting to another. You can change it or cancel it at any time.
A DMOST form differs from a DNR order in one important way: A DMOST form also includes directions about life-sustaining measures in addition to CPR, such as intubation, antibiotic use, and feeding tubes. The DMOST form helps medical providers understand your wishes at a glance, but it is not a substitute for a properly prepared advance health care directive.
An advance directive provides more information than a DMOST form, including details about your health care agent, more complete health care wishes, and your preference for organ donation. Therefore, even if you make a DMOST form, you should still complete an advance health care directive to provide a full set of wishes about your care.
You need to consider a DMOST only if you're facing a life-threatening medical condition. If you're healthy, you need only an advance directive to provide a full set of wishes for your treatment in the event of an unexpected accident or medical crisis.
On the other hand, a patient diagnosed with a terminal illness or frailty that requires care in a medical setting -- or ongoing care at home -- may need a DMOST in addition to traditional health care directives. That’s because an advance directive may not be enough to prevent medical personnel from resuscitating a patient in an emergency. For that, it's important to have a medical order such as a DMOST or DNR order. If you feel strongly that you don’t want emergency measures at the end of life -- or if you’re caring for someone who feels that way -- find out about making a DMOST in addition to traditional health care directives.
For more information about making an advance directive, see Delaware Living Wills and Advance Health Care Directives: What You Need to Know.
As mentioned above, medical professionals in Delaware used to be able to use a document called a MOLST form to keep track of a patient's preferences for health care at the end of life. However, in December 2013, the Delaware Division of Public Health requested that health care providers stop using the MOLST, because it believed the law authorizing the MOLST form did not support the ways in which it was being used. (See the announcement, DPH Requests Discontinuance of Its MOLST Form.)
In 2015, Delaware passed a new law, called the Delaware Medical Orders for Scope of Treatment Act. This law directed the Delaware Department of Health and Social Services to develop a standard DMOST form, which is now in use throughout the state.
If you've already made a MOLST form in Delaware, it may not be honored. You should make an advance directive -- and perhaps a DMOST form -- to replace it.
For general information about how to document your health care wishes, see the Living Wills & Medical Power of Attorney section of Nolo.com.