Should I Have a MOLST?

If you or a loved one has recently spent time in a hospital, nursing home, or rehab facility, you probably were offered the MOLST form as part of the intake interview.

What is a “MOLST” form? 

“MOLST” is the short name given to a form called “Maryland Medical Orders for Life-Sustaining Treatment.” The MOLST was developed to give individuals the opportunity to express their desires regarding the treatment they should receive if they are in a life-limiting situation. It replaced an older form called the Maryland “DNR” (“do not resuscitate”) form. The form is more comprehensive than the DNR and allows an individual to request to receive or not receive certain types of life-sustaining care.

How is a MOLST different? 

This document is not the same as an advance directive or a health care agent. If you have signed an advance directive or appointed a health care agent, you may still need to have a MOLST. This is because an advance directive is a legal document that may be open to interpretation. Emergency medical personnel, who often must make a decision in a hurry about whether to start life-support procedures, will only follow the instructions on a MOLST form. They are not qualified to read and interpret other types of legal documentation.

What’s included in a MOLST?

The MOLST differs from an advance directive by having simple checkboxes to indicate an individual’s resuscitation status. It provides instruction either to “Attempt CPR” or not. If the choice is for “No CPR,” the instructions may specify whether to offer respiratory support, by providing oxygen either by intubation or other means such as a face mask.

The second page includes orders for situations other than cardiac arrest, such as whether to provide ventilation, blood transfusions, transport to a hospital, antibiotics, artificially administered fluids and nutrition, and dialysis. These orders can include time limits or other specifications.

What makes a valid MOLST?

A form is a medical order and must be signed by a physician or nurse practitioner in order to be valid. A copy of a validly signed form must be presented to emergency medical personnel providing aid to a patient for the orders to be carried out. Without a valid MOLST, emergency medical personnel in Maryland will do everything necessary to sustain life while transporting the patient to the hospital.

Enacting a MOLST is a very personal decision. Anyone who has strong feelings about not being resuscitated should consider having one and making sure it would be available in any event. It’s a good idea to make multiple copies and make them available to anyone who may assist you in an emergency, including your in-home care provider.

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