MOLST
Your Living Will on Steroids
You, as a Maryland resident, have a new and powerful tool at your disposal to ensure doctors and hospitals respect and follow your wishes for your end of life medical care. This tool is called the MOLST (“Medical Orders for Life-Sustaining Treatment”) form.
Every adult person in Maryland should, as part of good planning, have a Living Will and a Health Care Power of Attorney (or an Advance Directive that combines both a Living Will and a Health Care Power of Attorney).
These documents accomplish two goals:
- Allow you to declare your wishes for end of life medical care
- Name a health care agent to speak for you regarding your medical care if you cannot speak for yourself.
However, Living Wills and Health Care Powers of Attorney have substantial limitations. Medical staff cannot act on the provisions of Living Wills and Advance Directives without medical orders implementing the provisions. Additionally, health care agents may be unavailable in emergency situations to make health care decisions for you.
The MOLST form helps to correct these limitations. To be clear, YOU SHOULD STILL HAVE A LIVING WILL AND A HEALTH CARE POWER OF ATTORNEY. The MOLST serves as an additional tool to ensure that medical staff follows your wishes for medical care.
A doctor or a nurse practitioner must fill out the MOLST form in consultation with you or your health care agent. Once signed by the doctor or nurse practitioner, the MOLST form becomes a valid and powerful medical order that must be followed by medical staff and must follow you as you transfer medical facilities. For example, if you enter a nursing home and the nursing home doctor signs a MOLST form in consultation with you and you are transferred to a hospital, the MOLST form must accompany you to the hospital and remains a valid medical order that the staff at the hospital must follow.
You should consider the following important points:
- The Maryland Legislature passed the MOLST Law in 2011 and the Law became effective on October 1, 2011. Final regulations for hospitals and other medical care institutions are pending.
- The MOLST form includes numerous choices for end of life care including CPR options, ventilation options, transfusion options, hospitalization options, antibiotic options, artificial feeding and hydration options and dialysis options.
- You do not have to wait for an illness to have a MOLST form signed by your doctor or nurse practitioner in consultation with you.
- You absolutely do not have to have a MOLST. While a powerful tool, no doctor, hospital or health care facility may require you to have a MOLST.
- As part of your personal planning, you should discuss your wishes for end of life medical care with your family, with your health care agent and with your health care provider.
- The MOLST form replaces the Maryland Emergency Medical Services Do Not Resuscitate (EMS DNR) Order form used by emergency medical services. However, all prior versions of the Maryland EMS DNR Order form do not expire and will still be honored.
- The MOLST form is not a living will or health care power of attorney. It does not replace the need for these important documents. It does not change your advance directive or living will. It does not change who has the legal authority to make decisions on your behalf if you do not have the capacity to make health care decisions for yourself.
- Beginning when final regulations are issued, nursing homes, assisted living facilities, hospices, home health agencies, dialysis centers and hospitals (hospitals only under certain conditions) must offer to complete a MOLST form in consultation with you.
- The original, a copy, and a faxed MOLST form are all valid orders.