The Maryland Department of Health & Mental Hygiene rolls out the new Medical Orders for Life-Sustaining Treatment form on October 1, 2011. 

Benefits

This form provides benefits to patients by causing their preferences for life-sustaining treatment to follow them throughout their treatment: "Every time a physician or nurse practitioner completes a MOLST order form, you will receive a copy for your records. If you do not have a Do Not Resuscitate (DNR) order on your MOLST form, medics in Maryland must attempt resuscitation. This form does not expire and it goes where you go – to the hospital, rehab, assisted living, and back home."

Risks

We regularly prepare Advance Directives (Medical Powers of Attorney) for clients and sometimes those Advance Directives are very specific in directing a particular course of treatment in certain circumstances.  Some clients with diabetes express preferences where profound amputation is at issue.  Other clients have addressed issues of advanced cancer treatments or treatments in the event of serious work-related injury where they have ultra-hazardous vocations.  The concern I have is this:

1. A patient executes a specific directive for their care;
2. Later, whether because of infirmity or oversight, they either fail to outline the same course in their MOLST or, worse yet, create a contradictory MOLST form;
3. Then, it appears the MOLST will control the action of the medical providers.  At the risk of stating the obvious, the result will be that their earlier well-considered decisions will likely be MOLeSTed.

Conclusion

For the time being, we address this issue with the use of a wallet card provided to our estate planning clients which provides immediate access of medical providers to your health care documents.  Be aware, however, that decisions for a particular course of treatment are no longer 'once and done' in light of Maryland's new MOLST.