New York health care proxies and living wills are traditional advance health care directives for adults 18 years of age and older. These documents are signed when people have capacity and only apply when they no longer have medical decision-making capacity. To complement the use of traditional advance directives and facilitate the communication of medical orders impacting end-of-life care for patients with advanced chronic or serious illness, the Medical Orders for Life Sustaining Treatment (“MOLST”) program was created. It contains specific and actionable medical orders that transition with the patient across health care settings. Health care proxies and living wills typically contain more general instructions, and cannot be followed by EMS providers in an emergency outside of a hospital or nursing home. A MOLST form contains legal and valid medical orders, but is not intended to replace traditional advance directives like the health care proxy and living will.
In contrast to a health care proxy, the MOLST applies as soon as a patient consents to the orders in it and a physician signs it. It is not conditional on a physician’s determination that a patient has lost medical decision-making capacity. The MOLST program is based on the belief that patients have the right to make their own health care decisions, including decisions about life-sustaining treatment, to describe these wishes to health care providers and to receive comfort care while wishes are being honored.
MOLST is generally for patients with serious health conditions. Physicians should consider consulting with the patient about completing a MOLST form if the patient:
- Wants to avoid or receive life-sustaining treatment.
- Resides in a long-term care facility or requires long-term care services.
- May pass away within the next year.
Patients with serious health conditions typically include those who have advanced chronic progressive illness and/or frailty (significant weakness and extreme difficulty with personal care activities) and those who may die or lose medical decision-making capacity in the next year. MOLST also may be appropriate for a patient with advanced age wishing to further define his or her preferences for care.
These patients may want to:
- Receive all appropriate treatment, CPR.
- Avoid all life-sustaining treatment.
- Limit life-sustaining treatment.
- Avoid any attempt to initiate CPR and prefer to Allow Natural Death (DNR order).
- Avoid placement of a tube down the throat into the windpipe connected to a breathing machine (intubation) and request a DNI order.
Call or text Rochester Estate Planning Attorneys Friedman & Ranzenhofer, PC at (585) 484-7954 to have your advance health care directives prepared.