Can a person change his or her mind about treatment after they fill out the MOLST?
Yes. They can ask for and receive needed medical treatment at any time, no matter what the MOLST form says. And, a person can also void the MOLST form and/or ask a physician, nurse practitioner or physician assistant to fill out a new form with different instructions at any time.
Does the patient have to go back to the original clinician to re-discuss the MOLST?
No. Changes to the MOLST form may be discussed, and the form updated if appropriate, by any physician, nurse practitioner or physician assistant providing care to the patient.
What if a patient wants to change one page of the MOLST form, but not the other?
Void both sides (destroy) of the old form and create a whole new MOLST form, with new signatures and dates.
What if a patient’s family member or significant other disagrees with the MOLST instructions?
If a patient has capacity to make health care decisions, the MOLST form is honored. If the patient loses capacity, the legally authorized health care agent has the legal right to reverse decisions on the MOLST form, but this might involve consultation with a care team or ethics committee if there is reason to question the motives of the health care agent. In outpatient settings, EMTs are trained not to get involved in conflict situations; EMTs would begin treatment and transport the patient to the hospital where the conflict would need resolution.
How do you change MOLST forms in the Electronic Health Record (EHR)?
MOLST forms that are scanned into an EHR system cannot be altered. Each institution needs a system for “flagging” changes to MOLST forms. The system needs to clearly indicate dates and indicate which form is the newest/current MOLST form. If the MOLST form is voided and no new MOLST form is filled out, there are no limitations of treatment in effect. This, too, needs to be clearly indicated in the EHR system.