What if there is a MOLST and a CC-DNR that say different things?
For cardiac or respiratory arrest, follow the most recent orders. In other situations, follow the MOLST orders.
What if there are multiple MOLST forms for the patient, and they say different things?
Follow the most recent orders.
What if a patient’s family member or significant other disagrees with the instructions on the MOLST form?
If a patient has capacity to make health care decisions, the MOLST form should be honored. If the patient loses capacity, an invoked health care agent has the legal right to reverse decisions documented on the MOLST form, but the health care agent should consider his/her understanding of the patient’s wishes and goals of care. If those wishes are not know, then his/her understanding of the best interest of the patient should guide their decisions. If there is conflict, then consultation with a care team or ethics committee would be recommended. In outpatient settings, EMTs are trained not to try to resolve conflict situations if they arise; EMTs would begin treatment and transport the patient to the hospital where the conflict would need to be resolved.
Now that the MOLST form is in use, is the Massachusetts Comfort Care/Do Not Resuscitate Order Verification Protocol form (CC/DNR form or “Comfort Care” form) still valid?
The Massachusetts CC/DNR form (“Comfort Care” form) remains valid. The CC/DNR form can still be used to document that a valid DNR order exists for a patient, and it will be honored by EMTs in outpatient settings. Because the MOLST (an actual medical order form) can be filled out to indicate “DNR” if that is the patient’s decision, the MOLST form can be used instead of the CC/DNR form. In some situations, patients may have both the MOLST and the CC/DNR forms. If both forms are present, in the event of cardiac or respiratory arrest, the most recent orders should be followed. In events other than cardiac or respiratory arrest, the MOLST orders should be followed.