Changing status quo can leave us overwhelmed

It cannot be assumed that a spouse, family member or friend will be authorized to make medical decisions on their loved one’s behalf in every situation or setting. —Massachusetts Health Web Site

In today’s world, we are mentally assaulted by so many changes to the status quo that we feel over whelmed. Information surrounds us.  In fact, because there is so much information, some of it is bound to be wrong.  Here are some common questions: What is the bottom line regarding my health insurance under the Affordable Care Act?  How can I be sure I’m not missing important deadlines for signing up for the programs I need?  How is Medicare changing?  In the old days, I knew when I was in the hospital.  Now, I find out I can stay there several days but I haven’t been “admitted.” My lawyer told me I need advance directives and a living will.  Now I’m at the hospital and they are saying I need a MOLST form.  What should I do?

Today, we’ll take the last question first.  Here’s why:  I recently met with a client whose MOLST form contradicted the choices she had previously made in our office for her Living Will. She was in my office for another matter.  However, when a policeman stops you for speeding and then notices that your seat belt isn’t fastened he can write a ticket for both the speeding and lack of seatbelt wearing. That’s like this case.  The client was in the office for something else, but when she showed me her MOLST form, it called for more conversation.

What is the different between MOLST and advance directives, and do you need them all?  The short answer?  Yes.  The explanation is longer.  Read on.

During the 2011 session of theMarylandlegislature, the Governor authorized the development of a Medical Orders for Life-Sustaining Treatment (MOLST) form to continue implementation of the Health Care Decisions Act.   The MOLST form is a “medical order” from a physician or nurse practitioner.  It is an order to other health professionals with instructions about a person’s medical care. It translates a hospitalized person’s goals for care and preferences into actual medical orders. In the best sense, Molst is based on effective communication of patient wishes, and documentation of those wishes into a medical order.  Think of it as being similar to a prescription. It is not considered an “advance directive.”

In you do not have a Do Not Resuscitate (DNR) order on your MOLST form, medics inMarylandmust attempt resuscitation.  It might be helpful to think of MOLST as being like the “old” DNR forms.  The form does not expire and it is supposed to go where you go – to the hospital, rehab, assisted living and back home.

A MOLST form is for a person of any age (including children) with an advanced illness, for example, life-threatening disease or injury, chronic disease, dementia or medical frailty.  This form does allow patients a complete range of options for their care, from choosing all available life-sustaining treatments to limiting or refusing those treatments.  Because it provides those choices, it is understandable that people have difficulty keeping all the forms separate in their minds.

A Health Care Power of Attorney (HCPOA), living will and the MOLST form are different documents and used for different purposes based on the patient’s condition and circumstances. Most commonly, the HCPOA should be completed as soon as possible after a person turns 18 and before a medical emergency may occur, such as a serious accident or illness.

The HCPOA names a health care “agent” who is authorized to make medical decisions for you if you lose the ability to make your own medical decisions.  A “living will” is a written document that allows a patient to give explicit instructions about medical treatment to be administered if the patient is terminally ill, permanently unconscious, or in similar end-stage conditions.

A living will extends the principle of consent, whereby patients must agree to any medical intervention before doctors can proceed. It allows you to guide your health care for the future when you may be too ill to make decisions concerning care. It can be revoked by you at any time. A living will preserves personal control and eases the decision-making burden of a family.  It is a type of advance directive that may be used by a person before incapacitation to outline a full range of treatment preferences or, most often, to reject treatment.

HCPOAs and living wills are called advance directives.  They are legal forms, not medical physician’s orders.  You may decide in the future that you want a treatment that you did not want in the past.  Remember, as long as you are able to make your own decisions, you can change your advance directives and ask your doctor to change your MOLST orders.

Thank you for reading.  Stay well.  See you next week