You may have heard about a new kind of health care directive in Maryland, called a Medical Orders for Life-Sustaining Treatment (MOLST) form. Here, we discuss what the MOLST form is and when you might need one.
A MOLST form is a medical professional'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. In Maryland, MOLST forms have replaced DNR orders, though existing DNR orders are still valid. The MOLST form may also provide other information about your wishes for end-of-life health care, as explained below.
In Maryland, a physician, physician's assistant, or nurse practitioner can help you create a MOLST form when you enter a health care setting such as a hospital, nursing home, or hospice care in a facility or at home. The health care provider must sign the MOLST form to make it valid. (See Maryland Statutes § 5-6081.) If a member of the medical staff does not ask you whether you want to create a MOLST form, you may ask for one.
A MOLST form is usually printed on brightly colored paper so it will 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 MOLST form differs from a DNR order in one important way: A MOLST form also includes directions about life-sustaining measures in addition to CPR, such as intubation, antibiotic use, and feeding tubes. The MOLST form helps medical providers understand your wishes at a glance, but it is not a substitute for a properly prepared advance directive.
An advance directive can give more information than a MOLST form, including details about your health care agent, more complete health care wishes, and your preference for organ donation. Therefore, even if you have a MOLST form, you should complete an advance directive to provide a full set of wishes about your care.
You need to consider a MOLST 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 MOLST in addition to a traditional health care directive. 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 MOLST. 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 MOLST in addition to an advance directive.
For more information about making health care directives, see Maryland Living Wills and Advance Directives: What You Need to Know.
For general information about how to document your health care wishes, see the Living Wills & Medical Powers of Attorney section of Nolo.com.