MOLST: Do not sign away your medical decision-making

A new form of advanced care planning (ACP) is being increasingly implemented in the Commonwealth of Massachusetts, which is identified by the acronym MOLST or a Medical Order for Life-Sustaining Treatment – a document which requires a cautionary attitude on the part of the Catholic faithful. Following is information compiled by the Diocese of Worcester about the MOLST and how Catholics should approach this document.

• Is using the MOLST form voluntary?

When or if you are asked to complete a MOLST form, remember that it remains voluntary and no one must complete one.  Even a duly-executed MOLST form can be changed or nullified at any time, either by the competent patient or the healthcare proxy (HCP).
• How do you complete a MOLST, and what you should not do?

While the Diocese of Worcester does not endorse this form of ACP, only consider doing so if your primary care physician (or other healthcare professional) engages you in communication describing and discussing the medical implication of your choices.  Decline to fill-in a MOLST form on your own.

• What does a MOLST do?

MOLST becomes “an actionable medical order” which healthcare providers must abide by, though they should verify that the MOLST form you carry with you or that has been scanned into your medical record reflects your current position.  Upon presenting the completed form, MOLST directs the care you will receive across various healthcare settings – hospital emergency rooms, ambulance transfers, long-term care settings, non-emergency treatment or urgent care facilities.

• Are there differences among various healthcare documents that direct clinicians to do or not to do certain procedures?

The various acronyms used for healthcare documents can be confusing to the patient.  Code status orders such as Do Not Resuscitate (DNR) differ from creating a MOLST form.  DNR orders decline mandatory resuscitation techniques that MUST be implemented in all situations unless you have agreed NOT TO BE RESCUSCITATED in the event of a cardiac arrest.

• How do I know what I will need down the road if I’m not terminally ill now?

It is difficult for any competent and relatively healthy person to determine in advance what medical treatments will be beneficial and therefore ethically required versus a treatment that will be burdensome, and hence, optional.

• Are there burdensome medical procedures which I can morally refuse?

The Catholic Church accepts as morally justified refusing or discontinuing over-zealous treatments “that are burdensome, dangerous, extraordinary, or disproportionate to the expected outcome” (CCC, n. 2278).

• What should I do if I want to avoid unnecessay medical procedures?

The safest method to assure that your preferences in such life-and-death matters are safeguarded is to appoint a healthcare proxy who understands that you want every reasonable chance to live and to do so in accord with the moral teachings of the Church.

• What if I am worried about someone hastening my death?

While every proposed medical treatment is not required by the Church, overly-burdensome (viz. extraordinary or disproportionate) treatment can morally be refused.  The alternative to completing a MOLST form and possibly being undertreated is that all Catholics are highly encouraged to designate a healthcare proxy (a durable power of attorney) who can speak on your behalf when you are no longer able to do so.  When the healthcare proxy knows your desire to live and die in conformity with Church teaching, how you have lived and the important life-long values that have influenced your life, then he or she can more effectively determine which medical treatment offers the best chance for you to continue to live or, conversely, would impose such burden on you that it can be legitimately refused.

– This Q&A may also be found on the diocesan website at http://www.worcesterdiocese.org/molst.
A copy of the Roman Catholic Health Care Proxy form can be found on the Massachusetts Catholic Conference website.
If you would like a printed health care proxy mailed to you, please email aledoux@worcesterdiocese.org in the Respect Life Office with your full mailing address.