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Advanced Care Directives

MOLST: Massachusetts Medical Orders for Life-Sustaining Treatment

What is MOLST?

Massachusetts Medical Orders for Life-Sustaining Treatment (MOLST) is a medical order form (similar to a prescription) that relays instructions between health professionals about a patient’s care. MOLST is based on an individual’s right to accept or refuse medical treatment, including treatments that might extend life. In Massachusetts, patients with a serious advanced illness at any age may discuss filling out a MOLST form with their clinician. The patient’s decision to use the MOLST form must be voluntary.

Before filling out a MOLST form, the signing clinician (physician, nurse practitioner or physician assistant), the patient and family members/trusted advisors should discuss the patient’s current medical condition, what could happen next, the patient’s values and goals for care and any possible risks and benefits of treatments that may be offered. After these discussions, the MOLST form may be filled out and signed by the clinician to instruct other health professionals about the use of life-sustaining treatments for the patient. The patient must sign their MOLST form. The signed MOLST form stays with the patient and is to be honored by health professionals in any clinical care situation.  

Please note, MOLST is not a health care proxy form. All adults aged 18 and older are recommended to fill out a health care proxy form to name the person who can make medical decisions for them in the future event of an unexpected illness or accident. Anyone with a MOLST form is also recommended to fill out a health care proxy form.

  
Learn more about MOLST by reading FAQs or watch the video.
 
To download the MOLST form and to read instructions for printing, click here.
  

For further information, visit:

 

Frequently Asked Questions

Why might a patient NOT want CPR?

CPR is a vigorous emergency procedure and it is not always successful. Experience has shown that CPR does not restore breathing and heart function in patients who have widespread cancer, widespread infection or other terminal illness. 

A patient may not want CPR attempted when:

  • There is no medical benefit expected. CPR wasn't meant for people who are terminally ill or have severe health problems. CPR is not likely to be successful for these people.
  • Quality of life would suffer. Sometimes CPR is only partly successful. Though the patient survives, they may suffer damage to the brain or other organs or permanently may be dependent on a machine to breathe. This can be particularly true for the elderly and very frail.
  • Death is expected soon. Persons with terminal illness may not want aggressive interventions but prefer a natural peaceful death.
Why are patients and families asked about CPR decisions?

Patients have the legal and moral right to accept or refuse medical treatments, including CPR. Like many aspects of health care, the decisions about treatment are made together by the patient (or when a patient is unable to speak for him/herself, a health care proxy or family member) and the physician and other health care providers.

What happens when CPR is given?

Basic CPR includes vigorous chest compressions to restore heart function and mouth-to-mouth breathing to restore lung function. 

Advanced CPR offers additional interventions which can include:

  • Intubation - The insertion of a tube into the mouth or nose to help with breathing.
  • Mechanical Ventilation - The use of a machine to move air into the lungs.
  • Medications - Given through a vein, drugs can help with blood pressure regulation, heart rhythm, and blood flow.
  • Cardioversion - The use of a controlled electrical shock to change heart rhythm.
How should I make the decision about DNR?

Like all health care decisions, a decision about resuscitation should be based on a combination of your own values and preferences together with the medical facts and options for treatment. This should occur in a conversation with your physician and other health care providers that you know and trust. Talk to your doctor about what he/she would recommend, knowing you and your condition. Think about what is important to you and talk to family members and friends. It may be helpful to seek counseling from clergy, therapists or social workers, especially when you are making a decision for someone else.

If I change my mind about a DNR orders, what should I do?

To change a DNR orders, talk to your physician. Because the DNR orders are a physician's order, the physician must be involved to change it.

Does a DNR orders change other aspects of medical care?

No, not without a specific discussion about it. All other medically indicated treatment is continued, unless you decide to limit it.

If I can't speak for myself, who decides about resuscitation order?

If you are unable to communicate your wishes, the health care team relies on your advance care directives (such as a health care proxy or living will). If these are unavailable, a family member is asked to make decisions for you, based on what he/she believes are your wishes.

Where can I get more information?

Talk to your physician, nurse or other members of your health care team. If you are not currently an inpatient at Brigham and Women's Faulkner Hospital, please contact your regular primary care physician (PCP) for more information about DNR orders.

Glossary of Terms

Cardiac Chest Compression:
The force applied by pressing with both arms over the mid-chest to restore circulation of blood by the heart. Because a great deal of force is needed, there can be injury to the surrounding area as a result. 

CPR:
Cardiopulmonary Resuscitation: The vigorous emergency procedure to restore heart and lung function in someone whose heart or lungs have stopped working. Basic CPR involves chest compression and mouth-to-mouth breathing. Advanced CPR includes the use of medications to regulate blood pressure and heart rhythm, controlled electrical shock to change heart rhythm, and intubation and mechanical support of breathing.

DNR order:
The physician's order to withhold resuscitation. No CPR.

DPH Comfort Care/DNR:
The Massachusetts Department of Public Health document that verifies to emergency medical personnel that the person does not want resuscitation. 

Cardioversion or Defibrillation:
The use of controlled electrical shock to treat certain kinds of heart rhythm problems. 

Intubation:

A tube inserted through the mouth or nose to open the person's airway to assist with breathing. Intubation prevents a patient from talking or eating by mouth.

Mechanical Ventilation:
The use of a machine that pumps air into the lungs of a person who is unable to breathe on his/her own. 

Medications for Advance Life Support:
The use of very potent medications given through the veins that help to correct problems with blood pressure ("pressors"), heart rate and rhythm.

Resuscitation:
The use of basic or advanced life support treatments in an emergency situation begun when someone has stopped breathing or whose heart has stopped beating.

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