MOLST

Jan 10, 2013Choosing Options for Life-Sustaining Care: Advance Directive Will Ensure Your Wishes Are Followed

The Chicago Tribune
January 9, 2012

Mr. J. had an implantable cardioverter defibrillator (ICD) for advanced heart failure. Having survived one episode of cardiac arrest, in which he nearly died, he was at high risk for another episode caused by a rapid, unorganized heart rhythm called ventricular fibrillation. Should this happen, the ICD would shock his heart back into normal rhythm. But at his daughter’s wedding, the ICD fired nine times. Each time, it saved his life, but the painful episodes terrified him, and he asked that the ICD be turned off.

Dr. Eva Chittenden, associate director of palliative care at Harvard-affiliated Massachusetts General Hospital, met with Mr. J. to explore his decision further. He stated that he’d already been hospitalized five times within 12 months, and he felt this took too much time away from his family.

They discussed his personal values and what action he’d want taken if his heart stopped, and the ICD was no longer there to revive him.

After long talks with Dr. Chittenden and his family, Mr. J. chose a “Do Not Attempt Resuscitation/Do Not Intubate (DNAR/DNI)” order. The decision meant he could continue seeing his cardiologist and other doctors, remain on his medications, and return to the hospital for intravenous diuretics. But he would not be revived if his heart stopped.

Doctors wish all their patients would make their preferences known in advance, like Mr. J. did. More

Nov 26, 2012Care at the End of Life

The New York Times
November 24, 2012

Three years ago, at the height of the debate over health care reform, there was an uproar over a voluntary provision that encouraged doctors to discuss with Medicare patients the kinds of treatments they would want as they neared the end of life. That thoughtful provision was left out of the final bill after right-wing commentators and Republican politicians denounced it falsely as a step toward euthanasia and “death panels.”

Fortunately, advance planning for end-of-life decisions has been going on for years and is continuing to spread despite the demagogy on the issue in 2009. There is good evidence that, done properly, it can greatly increase the likelihood that patients will get the care they really want. And, as a secondary benefit, their choices may help reduce the cost of health care as well.

Many people sign living wills that specify the care they want as death nears and powers of attorney that authorize relatives or trusted surrogates to make decisions if they become incapacitated. Those standard devices have been greatly improved in recent years by adding medical orders signed by a doctor — known as Physician Orders for Life Sustaining Treatment, or POLST — to ensure that a patient’s wishes are followed, and not misplaced or too vague for family members to be sure what a comatose patient would want.

Fifteen states, including New York, have already enacted laws or regulations to authorize use of these forms. Similar efforts are under development in another 28 states. The laws generally allow medical institutions to decide whether to offer the forms and always allow patients and families to decide voluntarily whether to use them.

With these physician orders, the doctor, or in some states a nurse practitioner or physician assistant, leads conversations with patients, family members and surrogates to determine whether a patient with advanced illness wants aggressive life-sustaining treatment, a limited intervention or simply palliative or hospice care. More

Oct 21, 2011New end-of-life health care regulations to take effect

Delmarvanow.com
October 10, 2011

SALISBURY — It is never easy to make end-of-life health care decisions for yourself or a loved one.

Health care professionals and lawmakers in Maryland have recognized the process and paperwork involved with medical treatment options is often cumbersome, confusing and overwhelming for many patients and their families.

In an effort to minimize concerns and streamline the decision-making process, a new regulation in Maryland, referred to as Maryland MOLST — Medical Orders for Life Sustaining Treatment — has been initiated to help guide patients and health care professionals through the process and ensure the patient’s wishes for medical care are carried out.

The law, scheduled to go into effect this year, requires a Maryland MOLST form be completed by or for all individuals admitted to nursing homes, assisted living facilities, hospices, home health agencies, and dialysis centers.

The MOLST form is intended to help physicians and other health care providers discuss and convey a patient’s wishes regarding cardiopulmonary resuscitation and other life-sustaining treatments.

MOLST orders should be completed for any person who wants to avoid or receive life-sustaining treatments; lives in a long-term care facility or requires long-term care services; or is at risk of dying within the next year.

“The MOLST form should prove to be beneficial to both patients and providers because it delivers specific orders for medical treatment and will be recognized in a variety of health care settings,” said Stephanie Mitchell, director of clinical operations at Peninsula Home Care.

“It will also help patients and decision makers understand life-sustaining treatments and discuss them with health care practitioners.”

Completion of the MOLST form will begin with a conversation between the patient and a qualified, trained health care professional.

The process allows any health care professional to define the patient’s goals for care, review possible treatment options on the MOLST form and ensure shared, informed medical decision-making.

All MOLST orders, however, must be signed by a Maryland licensed physician or nurse practitioner.

For more information on Maryland MOLST, visit www.peninsulahome care.com.

Feb 10, 2011New law takes effect statewide for terminally ill

By Julie Sherwood, staff writer
Messenger Post
Posted Feb 09, 2011

Finger Lakes, N.Y.-A new law in effect beginning today requires doctors and nurse practitioners to offer terminally-ill patients information and counseling concerning palliative care and end-of-life options.

“Typically, patients are only referred to hospice two or three weeks before their death,” stated
Dr. Patricia Bomba, vice president and medical director of geriatrics for Excellus BlueCross
BlueShield. “This new law requires physicians and nurse practitioners to discuss palliative care,
hospice and all their other options earlier in the course of the patient’s illness.”

The New York State’s Palliative Care Information Act encourages discussions between patient
and physician about the goals for care and also the need for a Medical Orders for Life-Sustaining
Treatment (MOLST) form, as well as ensures optimal relief of pain and other symptoms and a
timely referral to hospice.

More information, at CompassionAndSupport.org

Oct 21, 2010Atul Gawande: How to Talk End-of-Life Care with a Dying Patient

Compassion & Choices has long been a leader in the effort to empower patients to make their own end-of-life decisions. Five states now have expanded end-of-life choice, including New York and California.

In July, Dr. Atul Gawande published a much talked about article on aggressive medical interventions for dying patients–and how patients and doctors must work together to decide priorities for how and when to treat illnesses for those facing the end of life.

In October, Dr. Gawande discussed the four important points for doctors to discuss with terminally ill patients about their end-of-life care. Instead of pressing patients to make hard decisions, Gawande emphasizes the importance of asking questions about their hopes and fears.

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