DNR, MOLST, Health Care Proxy, and Advanced Directive
The “Do Not Resuscitate” (DNR) law was created to advise ambulance services, EMTs, paramedics, and other care providers that the patient and the patient’s physician have agreed to the patient having “DNR” status. Even though the DNR is still honored (for now), there is now a much better document: Medical Orders for Life Sustaining Treatment, the MOLST.
The MOLST contains a range of choices in addition to the Do Not Resuscitate. The patient’s additional choices contained in the MOLST are on the topics of ventilation, transfer to the hospital, intubation, dialysis, artificial nutrition, and artificial hydration. The MOLST is recommended for patients of any age with a serious medical condition. The official form can be found at this site: http://www.mass.gov/eohhs/gov/departments/dph/programs/hcq/oems/comfort-care.
If appropriate, print the MOLST on bright pink paper and take it to your physician for the discussion. After completion of the form, both the patient and the physician must sign it. Like the DNR, the MOLST must follow the patient wherever the patient goes so all caregivers are properly advised. The MOLST does not replace the health care proxy nor the advance directive.
Every person age 18 or older should have both documents. In the health care proxy, the patient names a number one and a number two agent to make health care decisions if the patient becomes unable to make or communicate his/her health care decisions. This simple document avoids an awful probate court proceeding called a “guardianship.”
The advance directive, also known as a living will, directs, in advance, what the person signing (“the principal”) would want if the principal, in the future, is in a terminal or permanent vegetative condition without a reasonable expectation of recovery. Most people choose to be allowed to die a natural death and not have their life prolonged artificially; however, the principal can make any choice he/she desires.