Ensuring Your Decisions are Honored with a Living Will

Roswell Park
Friday, April 29, 2016 - 1:26pm

For most of us, filling out forms isn’t a favorite task and it becomes even less so when dealing with sensitive issues surrounding our life. Approximately 55 percent of American adults do not have a will, so clearly it’s not an activity people enjoy doing at the best of times.

While thinking about life and health issues may be emotionally taxing, making plans and decisions ultimately serves every patient’s best interests. And the upside is that once you’ve made plans and shared them with loved ones, you are less likely to feel anxious about your future, knowing that you are prepared for possible situations, with your individual rights protected.

Creating a health care proxy, a living will and MOLST (Medical Orders for Life-Sustaining Treatment) form are relatively simple ways to ensure that your decisions are honored. These legal forms guarantee that your health care decisions are respected and if necessary, made by people you trust.

Health Care Proxy

A health care proxy is a legal document that assigns one or more persons to make health care decisions for you if you are unable to make those decisions for yourself.

Typically, people ask a family member or close friend to be listed as their health care agent. Your agent will represent you if you are temporarily or permanently unable to make your own health care decisions. An agent only has this authority while a patient is not able to advocate for themselves. Once a patient is again able to make his or her decisions, the health care agent no longer has any authority.

It’s important to be very specific with your agent regarding how you want them to act on your behalf, including what types of treatments you would or would not want under different types of circumstances. Consider providing a list that includes decisions such as whether you would want life support initiated, continued or removed if you were in a permanent coma, and whether you would want nutrition and hydration initiated, withheld or continued under specific types of circumstances.

Hospitals, doctors and other health care providers must follow your agent's decisions as if they were your own. You may give the person you select as your health care agent as little or as much authority as you choose. The health care proxy may also be used to document your instructions regarding organ and/or tissue donation. A comprehensive guide to preparing a health care proxy is available through the NYS Department of Health.

If you live in another state, visit your State Health Department as forms may differ.

Living Will

A living will – sometimes called a health care declaration - is a document that allows people to state what type of health care they want to receive if they cannot speak for themselves. Having a living will allows you to leave written instructions that explain your health care preferences, especially regarding end-of-life care. You cannot use a living will to name a health care agent, which is why it is important to have a health care proxy as well.

You may include any choices regarding medical care in your living will as well specific instructions for certain types of care that you want or that you don’t want. For example, you may instruct that you be put on a ventilator if required, or instruct that you should never be put on a ventilator.

Your state’s form will request information about various types of care, including: life-prolonging medical care, food and water and palliative care. In making these decisions, most people will think not only about what they want, but also how those choices will affect loved ones. Ultimately, each person has the right to make his or her own decisions and if included in a living will, these decisions are legally binding.

MOLST

A medical orders for life-sustaining treatment form, or MOLST form, conveys a patient's wishes regarding cardiopulmonary resuscitation (CPR) and other life-sustaining treatments.

A MOLST form is intended for patients with serious health conditions who want to approve or reject any or all life-sustaining treatments, or receive services in a long-term care facility.

Completion of the MOLST form typically involves conversations between the patient, the patient's health care agent and a qualified health care professional who can review the patient's goals for care and treatment options. A licensed physician must always be part of the patient's discussion regarding diagnosis, prognosis, goals for care, treatment preferences, and consent by the appropriate decision-maker. Once the patient’s preferences are determined, that same physician will sign the MOLST form.

The MOLST form is beneficial to patients and providers as it provides specific medical orders such as do not resuscitate (DNR) and do not intubate (DNI) orders and is recognized and used in a variety of health care settings.

A signed MOLST form should be transported with patients if they travel to different health care settings. The medical orders on the form need not be re-issued by the patient's new health care provider, but should be reviewed and may be revised by a physician, when the patient moves to a different setting and when the patient's preferences and/or medical conditions change.

Get more information about MOLST forms, including helpful checklists and frequently asked questions.