Medical Orders for Life-Sustaining Treatment - Professionals

Forms - Who Should Complete a MOLST Form

Health care professionals should discuss MOLST with their patients who have advanced progressive chronic illness, are terminally ill or are interested in further defining their care wishes. Specifically, health care professionals should discuss MOLST with their patients if the patients/residents:

• Want all appropriate treatments including cardiopulmonary resuscitation (CPR).
  
• Want to avoid all life-sustaining treatments.
  
• Choose to limit life-sustaining treatments.
  
• Want to avoid cardiopulmonary resuscitation (CPR) by requesting a “Do Not Resuscitate Order” (DNR order).
  
• Might die within the next year.
  
• Reside in a long-term care facility.
  
• Reside in the community and are eligible for long-term care.

Health Care Professionals using MOLST need to be aware of the patient’s goals of care and share existing medical evidence with patients to facilitate their decision-making.

For example:

Cardiopulmonary resuscitation (CPR) is intended to prevent sudden, unexpected death and is generally not indicated in cases of:

1. Terminal, irreversible illness where death is expected, or
   
2. In certain medical situations where CPR is deemed ineffective.

For many people resuscitation is unwanted, unneeded and impossible. Depending on the situation and the person’s preferences, CPR may be inappropriate, futile and undignified.

Statistics to keep in mind when having discussions about CPR:

• Survival rate of CPR on television shows: ---------------------> 66%
  
  
• Actual in-hospital survival rates for CPR:
  
  
  • All hospital patients: ---------------------------------> 15%
    
    
  • Frail elders*: -------------------------------------------> <5%
    
    
  • Individuals with advanced chronic illness**: -> <1%

* An older person with trouble performing activities of daily living because of weakness or fatigue. Frail elders are more vulnerable to acute illness due to low activity level.

**Advanced chronic illnesses such as Alzheimer’s, Parkinson’s or end-stage heart, lung or kidney disease.

Click here to view the PowerPoint presentation on Myths and Truths of CPR: Conversations Based on Evidence [pdf]