Maryland Medical Orders for Life Sustaining Treatment
Our Position:
Any paperwork addressing life sustaining treatment, particularly end of life treatment must have
- A place for the patient or the patient's representative to sign off indicating they are both aware of what the form orders and that they agree
- A clear statement that participation by the patient or the patient's representative iis voluntary
- A clear direction that only full resusication be indicated in cases where the patient or the patient's representative chose not to partcipate
- A mechanism to ensure that the patient or the patient's representative receive a copy of any such orders immediately in order to check for accuracy
Recent Developments:
September 20, 2011: As a result of continued work by groups advocating for the rights of hospital patients and people needing long-term care services, another round of public comment and additional deliberation on the content of the MOLST form has been ordered. Click here to read the latest on this issue from Secretary Joshua M. Sharfstein, Department of Health & Mental Hygiene.
Click here send us any comments you might wish to have presented by Voices during this additional public comment.
The Issue:
The Maryland Medical Order for Life Sustaining Treatment is a form that the State of Maryland has mandated shall be filled out upon admission of a person to a Nursing Home, Assisted Living Facility, Hospital, Hospice, Kidney Dialysis Unit, or when a person hires a Home Health Agency. The form deals with alternative treatments a person could receive in the event that "life sustaining treatment" is needed. It covers CPR, intubation, hospital treatments, etc. To view the form click here.
The form is intended to be given to first responders - Emergency Medical Technicians, emergency room doctors, etc. When 911 is called, the form is supposed to go with the person to the hospital, directing the use of the listed life sustaining options. By law, if a person does not want to be resuscitated, intubated, or sent to the hospital for care, this form must say that. IF A THE PERSON'S WISHES ARE NOT KNOWN TO EXCLUDE THE LISTED ACTIVITIES, ALL POSSIBLE CARE, INCLUDING THOSE ACTIVITIES, MUST BE ADMINISTERED AS NEEDED. However, at any time two doctors declare the care will not be medically effective, IT CAN BE DISCONTINUED.
While the form "does not replace an advance directive" concerning the person's desires (according to the Department of Health and Mental Hygiene), in the real world it is unlikely that anyone is going to be able to produce the advance directive fast enough to prevent medical personnel from taking all possible measures. The MOLST form replaces the former POLST form that required the signature of the person or the individual with the person's Health Care Power of Attorney in order to ensure accuracy.
According to the Department of Health and Mental Hygiene, a person's participation in the filling out of the form by the physician, physician assistant, or nurse, is voluntary. However, according to the Physician who works with the state's Emergency Medical Technician Program, he would feel obliged to tell that person that, "CPR is painful. They break your sternum and may break several ribs administering it. In older adults, those ribs may never heal."
THE PERSON OR THE INDIVIDUAL NAMED IN THE HEALTH CARE POWER OF ATTORNEY IS TO BE OFFERED THE OPPORTUNITY TO PARTICIPATE IN THE PREPARATION OF THE FORM. Voices has two concerns about this.
1. The doctor or nurse may simply make an offhand remark that the person may participate, then go ahead and fill out the form the way he/she thinks it should read.
2. A person whose life has just been changed by the health care issues that initiated living in a nursing home could be adversely affected by being asked to immediately fill out the form upon admission, thus being forced to deal with likelihood of death as an outcome of those issues by talking about the items on the form.
The form is now law and will take effect by April 2012. The facilities listed above are required to have filled out a MOLST form for each person. Our challenge is to make sure everyone is aware that this form is now required, will be filled out for by a physician or nurse practitioner without any sign-off signature signifying agreement, and that it is imperative that every individual or responsible representative obtain a copy of the MOLST and review it for accuracy.