• When and How to Say No More: End-of-Life Options for Patients with Advanced Illness

By Carol Barton

When our lives are drawing to a close from serious illness or injury, we, or someone we chose to make decisions for us if we can’t, may have to make difficult health care choices. We know that and yet, according to a California Health Foundation survey, over 56% of Americans – the very ones who say they do not want their families burdened by end-of-life decisions, fail to discuss end-of-life choices with anyone. As morbid as it may seem to you – have that discussion now before a crisis occurs.

Take a case in point. A man was comatose and nearing death. Imagine the shock when the doctor asked his spouse “What were his wishes about end-of-life? Did he want a DNR/DNI or for medical treatment to continue?” Although her husband gave her power of attorney, they had never had the end-of-life discussion. The Massachusetts Medical Orders for Life-Sustaining Treatment (MOLST), an expanding standard of healthcare practice in MA, could have helped in this situation since the discussion might have been initiated and the MOLST form signed – thus resolving a painful, and perhaps the wrong, decision for her spouse.

MOLST is a standardized form that converts a seriously ill patient’s wishes for certain medically appropriate life-sustaining treatments into valid medical orders that can be honored by all health care professionals across the health care community. MOLST does not replace a health care proxy form; the proxy is used to name a person’s health care agent allowing that person to legally make medical decisions for you in the event that you cannot. Every adult aged 18 or over in Massachusetts should have a health care proxy form.  Importantly, while a person might have written “final wishes” or a “living will,” they do not carry the same authority as a medical order such as MOLST.

When is it appropriate to consider signing the form? That depends on your situation. However, every person with advanced illness or injury should consider filling out a MOLST form if:

  • It is medically appropriate, based on the person’s current health condition, and
  • The person wants to express preferences about life-sustaining medical treatments.

To access additional information about MOLST, visit the following website


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