State program gives end-of-life patients right to choose care options
Published 2:04 pm, Wednesday, October 4, 2017
The State Department of Public Health has launched a statewide program called Medical Orders for Life Sustaining Treatment, which gives patients approaching the end stage of a serious illness or who are in a condition of chronic progressive frailty the ability to choose the medical treatments for their end-of-life care.
“MOLST offers patients with life-limiting illnesses the opportunity to learn about the benefits and drawbacks of all treatment options and to make their wishes for end of life care known. It ensures that patient choices about life-sustaining interventions and end of life care options are documented as medical orders that are transferrable and respected across all health care settings,” said DPH Commissioner Dr. Raul Pino in a news release. “The MOLST document applies equally to patients who choose to continue treatment and who choose to decline any or all life-sustaining interventions.”
The MOLST program allows patients, in consultation with their healthcare providers, to specify what types of treatments they wish to receive toward the end of their life. Those wishes are documented by a clinician on an easily recognizable bright lime green form that is a portable medical order. The form remains with the patient and is used to direct the medical care for the patient across all settings. MOLST empowers a patient to make decisions along the whole continuum of end of life care, from very aggressive life sustaining care to comfort care only, including choices about resuscitation.
MOLST differs from an advanced health care directive like a living will, because it is an actionable medical order that remains with the patient and is used to direct the patient’s medical care. Often a living will or similar advanced directive is not readily available or questions exist about the qualifying conditions of a patient to trigger the documented wishes, which can lead to medical interventions that run counter to the patient’s wishes.
In 2014, Governor Malloy signed into law a bill that established a pilot MOLST program. The program, coordinated by DPH, ran in 13 settings across the state and included training for healthcare practitioners in hospitals, long term care facilities, and private practice. Nearly 150 patients were served by the MOLST pilot program. Based on the success of the three-year pilot program, the legislature earlier this year passed and the Governor signed into law a bill allowing MOLST to be made available throughout the state.
The MOLST program launched the beginning of this month and will be available throughout the state to licensed Connecticut physicians, physcian assistants and advanced practice registered nurses who have completed the MOLST training and their eligible patients. Training in MOLST is required prior to a provider’s participation in the program. For more information about MOLST, please visit www.ct.gov/dph and click on “Medical Orders For Life Sustaining Treatment” under Featured Links.