Why isn’t the MOLST form considered an Advance Directive?
The MOLST form is not an advance directive because it is a medical document that contains actionable medical orders that are effective immediately based on a patient's current medical condition. Advance directives, including health care proxies and living wills, are legal documents that are effective only after the patient has lost capacity. In other words, a health care agent can make decisions for a person only after he or she has been determined to lack capacity; a living will is relevant only after the patient can no longer be consulted. A MOLST form, on the other hand, is a medical document signed by both the clinician and the patient, and is effective as soon as it is signed, regardless of a patient’s capacity to make decisions.
Is the MOLST form different from other medical orders?
The MOLST form is a standardized medical order form that contains valid medical orders. These orders are the same as any other medical orders that are followed by health professionals. Policies and procedures about honoring MOLST orders should be integrated into the institution's standard practices for following medical orders (for example, for following verbal medical orders).
Is MOLST used the same way as a Health Care Proxy form?
No. Use of a Health Care Proxy form to appoint one's Health Care Agent is recommended for all adults, ages 18 and above, healthy or sick. The purpose, timing of use, intended users and content of the MOLST form are all very different from using a Health Care Proxy form to appoint one's Health Care Agent. Learn more about the difference between a Health Care Proxy form and MOLST. (Note: it is recommended for anyone with a MOLST form to also fill out a HCP form to appoint their Health Care Agent).
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.
Can a person change his or her mind about treatment after they fill out the MOLST?
Yes. They can ask for and receive needed medical treatment at any time, no matter what the MOLST form says. And, a person can also void the MOLST form and/or ask a physician, nurse practitioner or physician assistant to fill out a new form with different instructions at any time.