It’s always important to plan ahead for the future. When we are healthy and active, it’s natural to avoid thinking about what may happen if we were to develop a significant illness or injury. However, the best time to plan how our affairs will be managed during sickness is during times of good health. If we become seriously ill, what type of medical care do we wish to receive? Do we seek heroic measures, comfort care, or something in between? Who will make these decisions for us should we become incapable of making them ourselves? Fortunately, we have several tools at our disposal that make it easier to plan for such difficult times.
The MOLST (Medical Orders for Life-Sustaining Treatment) form was implemented statewide in Massachusetts in 2012. This form was created to help individuals document their goals of care should they develop a significant, life-altering illness. It is a legal document that guides physicians, family members, and other providers who deliver medical care.
The MOLST form represents an important advance in planning for end-of-life care. Until this form was adopted, health care providers relied on the DNR/DNI form which asked black and white questions about cardiopulmonary resuscitation (CPR) and intubation (breathing tube, ventilator) for life-threatening emergencies. However, as we all know, decisions related to health care involve many areas of gray, and the MOLST form recognizes some of these nuances.
While the MOLST form does include questions regarding CPR and intubation, it also addresses other less invasive forms of medical care. These questions include whether an individual wishes to receive intravenous fluids, artificial nutrition (feeding tube), non-invasive ventilation (bi-PAP or C-PAP), or dialysis. There are queries regarding duration of treatment and whether a person wishes to be transferred to a hospital for medical care.
The MOLST form should be completed in consultation with your physician. For more information, please see the following link: http://www.molst-ma.org
Healthy Care Proxy
When healthy, we are able to make informed decisions about our own medical care. What happens to an individual who becomes cognitively impaired and is no longer able to make such decisions? A health care proxy is someone who is given the legal authority to make medical decisions on behalf of another person. The health care proxy is not “activated” until an individual is deemed incapable of giving informed consent to medical treatment. When selecting a health care proxy, it is important to make sure the proxy understands a person’s wishes and goals of care should a serious illness develop.
The Commonwealth of Masssachusetts offers an easy-to-complete form by which a person may appoint two health care proxies (a primary health care proxy and a back-up). This form may be found here: http://www.massmed.org/healthcareproxy
After completing the MOLST form and selecting health care proxies, some individuals choose to create a living will. A living will is a written narrative by which a person describes their goals of care should they develop a serious illness. It serves as a guide for the health care proxy and medical providers when an individual is no longer able to express their wishes or make informed decisions regarding their own care.
Who Should Keep These Documents?
After creating these documents, it is important that these papers be made accessible to all parties who may be involved in that person’s medical care. This includes:
- Health care proxies (both the primary health care proxy and the back-up)
- Medical team (physicians, hospitals, home care providers)
- Immediate family members or close friends
- Estate attorney
Where Do I Get More Information?
Primary care physicians are available to guide patients with their decision-making process. Attorneys who specialize in estate planning may also provide counseling. The following websites offer helpful information:
National Institute on Aging Information Center https://www.nia.nih.gov/health/publication/advance-care-planning
Centers for Disease Control and Prevention (CDC) http://www.cdc.gov/aging/advancecareplanning
Wishing you good health,
Brad Weiner, MD
This blog is for informational purposes only. It does not replace medical care from a licensed physician. Please contact your doctor if you have any questions or concerns.