Make clear now your future treatment choices

A press release from DePaul University, received at work after my recent emergency hospital stay, brought home to me the importance of having my treatment wishes known for my future health care issues.

"Assessing Advance Care Planning: Examining Autonomous Selections in Advance Directive," is a De Paul University research study, which is published in the Journal of Clinical Ethics. The lead author Craig Klugman, chairman of DePaul's Department of Health Sciences, and co-author Nicole Tolwin, DePaul alumna and graduate student in nursing at the University of Illinois at Chicago, "found a correlation between a person's age and their request for interventions." Researchers found that people under age 50 use the documents to request more medical interventions; older adults use advance directives to refuse care.

The results showed that many individuals turned over their advance directives to an attorney or physician; fewer people actually had a conversation about the directive with a loved one. Of those who had conversations about advance care planning, most discussed it with a spouse or partner, followed by a child or a sibling.

Your decision maker needs to have guidance from you as to what your advance health care directive means. Don't just write or have the advance directive written without following up with a discussion with your family and especially your decision maker as to what you wish or value for your end of life.

"Having the document is important, but having the conversation is essential," Klugman said.

At a meeting of the Maryland Federation of National Active and Retired Federal Employees, our Service Officer informed the attendees that he had recently learned that the Maryland law on Do Not Resuscitate and Advance Directives has changed. Legislation was passed in 2011, which authorized development of Medical Orders for Life-Sustaining Treatment to better implement the provisions of the Health Care Decisions Act.

The Health Care Decision-Making Worksheet should be used to prepare for a discussion with your health care professional about your current and future health care treatment wishes and decisions. Do not complete the order form directly. Use the worksheet to make treatment decisions. Your physician or health care professional will then complete the MOLST order to reflect your wishes. Every time a physician or nurse practitioner completes a MOLST order, you will receive a copy for your records. If you do not have a Do Not Resuscitate order on your MOLST form, medics in Maryland must attempt resuscitation. This form does not expire and it goes with you — to the hospital, rehab, assisted living, nursing home and return to home.

The advance directive states your wishes for future medical treatment options. You may also designate who will make decisions for you should you lose the ability to make your own choices.

Make sure you take your Maryland MOLST order form and advance directive every time you go to a new doctor, the Emergency Room, hospital, or any other health care facility.

Maryland MOLST is a medical order form, not an advance directive. MOLST orders are effective immediately when signed, whereas treatment choices in an advance directive may not apply until some future time. The idea behind providing these treatment options in an advance directive is to allow patients to make choices that they want to apply in the future, while they have the capacity to do so and in case they lose that capacity.

Using MOLST, with the patient's informed consent, the doctor could issue medical orders for life-sustaining treatment such as palliative (comfort) care only; do not attempt resuscitation (allow natural death); do not intubate; do not hospitalize; no feeding tube; no IV fluids; do not use antibiotics; no dialysis and no transfusions. Health care providers should honor these orders in any setting, including emergency responders, when the patient is incapable of making medical decisions.

The goal is that the MOLST form will have a positive impact in Maryland in helping to ensure that the patients' wishes for their care are honored. It is a critical element in the quality of end of life care.

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