The Weekly Scenario: Advance Medical Directive Alternative
Question: My mother is supposed to sign her advance medical directive next week. We have both read it but now my mother is getting cold feet about signing it. What is the alternative to signing the advance medical directive?
Answer: The importance of the advance medical directive is something that cannot be overstated. But it also can be an intimidating document for many people, and some seem not able to get over their anxiety and therefore don’t ever sign it. The advance medical directive gives an individual the ability to expressly provide what they want in terms of their medical/health care treatment if the person were to become incapacitated. But advance directives can be difficult to navigate because they can be overly verbose and at times more legalistic in nature. Some people are simply not comfortable confronting the end of life decisions on a document that is difficult for them to understand. The advance directive contains both a health care proxy (ceding authority to an agent to make health care decisions) and the living will (desires for the end of life decisions). These documents can be broken out into more than one document and signed individually. At times, separating the document into two stand-alone documents (Health Care Proxy and Living Will) is easier for people to follow. To an extent, the document can be modified as well to allow for more simplified language.
There are other alternatives to an advance medical directive such as a document known as a “MOLST.” The MOLST is not ideal for everyone, but in some circumstances, it may be worthwhile. Under a health care proxy, the person can discuss with the agent beforehand what she wants in terms of health care and then give the authority to such agent. The MOLST or Maryland Order for Life-Sustaining Treatment form basically replaces the EMS/DNR form. The MOLST is a portable medical order covering cardiopulmonary resuscitation and other life-sustaining treatments based on the patient’s wishes and I see it used generally for older individuals who are being shuttled between nursing facilities, rehab clinics and/or home. One advantage of the MOLST is that the MOLST may be signed by a doctor or nurse practitioner. In fact, that is really what the MOLST is, a physician’s order. The MOLST form is valid across the continuum of care and is to be honored by physicians, nurses, and other health care providers, as well as EMS providers. The MOLST doesn’t replace the advance medical directive, but certain people express these wishes through the MOLST as a result of the succinct nature of the document. The hope (and requirement) is that the patient’s wishes if he or she has an advanced directive, is consistent with what is written in the MOLST.
Comment: The people who have MOLST orders are generally those that really are the most likely to be in need of resuscitation services and often times keep them on a plastic bracelet or necklace on their person. For others, I recommend that they have a fairly recently signed advance medical directive where they can review and ask questions well in advance of any emergency.
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