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What’s My Role?

Completion of the MOLST begins with a conversation or a series of conversations between the patient, the health care agent or the surrogate, and a qualified, trained health care professional using the 8-Step MOLST Protocol. The conversation(s) should be documented in the medical record.

Ideally, the health care agent and family should listen to the discussion when a patient is able to make MOLST decisions. If the patient had not previously completed a health care proxy and the patient has the ability to choose a health care agent, the patient should complete a health care proxy.

Patient

The patient has the right to:

Physician

When the physician signs a MOLST form, the physician is accountable for a thoughtful MOLST discussion and must:

Nurse Practitioner

As of May 28, 2018, when the nurse practitioner is able to sign a MOLST form, the nurse practitioner will be accountable for a thoughtful MOLST discussion, have the same obligations as a physician and must:

Other Members of the Care Team

Other members of the care team that are qualified and trained health care professionals must act within their scope of practice, meaning doing what they’ve been trained to do professionally.

Physician’s Assistant

The physician’s assistant cannot sign the MOLST form but can participate in thoughtful MOLST discussions in collaboration with the physician:

Nurse

The nurse can participate in a team based approach to MOLST discussions:

Social Worker

The social worker can participate in a team based approach to MOLST discussions:

Chaplain or Spiritual Adviser

The chaplain or spiritual adviser can participate in a team based approach to MOLST discussions:

Family

Ideally, the health care agent should listen to a thoughtful MOLST discussion and/or be informed of the patient’s values, beliefs and goals for care, as well as the preferences for care and treatment documented as medical orders on the MOLST.

The family must follow the patient’s preferences for care and treatment.  When a patient makes a decision to withhold life-sustaining treatment based on current health status and prognosis, MOLST orders to withhold treatment can only be changed by the patient.

Health Care Agent or Surrogate

If the patient is unable to make complex medical decisions on the MOLST, the health care agent stands in the shoes of the patient and is authorized to make MOLST decisions. The health care agent or surrogate must:

A health care agent and surrogate have rights and obligations.

What a Health Care Agent Cannot Do1

If the patient loses the ability to make MOLST decisions and the patient has already made decisions to withhold certain life-sustaining treatment (e.g. Do Not Resuscitate (DNR) and Do Not Intubate (DNI), the healthcare agent or surrogate cannot undo the patient’s decision.

What a Health Care Agent Can Do1

If the patient loses the ability to make MOLST decisions and the patient has requested full treatment for certain life-sustaining treatment, the health care agent or surrogate can make a decision to withhold and/or withdraw other life-sustaining treatment on the MOLST for which the patient requested full treatment, as full treatment represents the standard of care.

For example, a decision to forego future hospitalization, a feeding tube or other life-sustaining treatment can be made if it is consistent with known wishes or in the best interest of the patient, based on a major change in health status or prognosis.

1Bomba PA, Karmel J. Medical, Ethical and Legal Obligations to Honor Patient Preferences. NYSBA Health Law Journal Spring/Summer 2015; 20(2):28-33.

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