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Comprehensive healthcare planning never goes out of style. Continuous developments in medical science and the growing scrutiny imposed by medical providers make now, more than ever, an important time to ensure that your healthcare decisions are clear, concise and valid.

It is no secret that planning for healthcare-related decisions is confusing. However, the use of a MOLST form or AMD can provide clarity during this process. Note that these are separate documents, although many people use them interchangeably, especially for end-of-life measures involving decisions to not resuscitate or to remove feeding tubes.

What’s with all the acronyms?

What does MOLST stand for?
MOLST stands for Medical Orders for Life-Sustaining Treatment. A MOLST form may be available through your local treating doctor or nurse practitioner. The MOLST form provides individuals with the opportunity to express their wishes with regard to current treatments, resuscitation or other life-sustaining treatments and to have their doctor or nurse practitioner create immediate actionable medical orders for those individuals to give to any healthcare provider.

What does AMD stand for? AMD stands for Advance Medical Directive. Generally, a Maryland Advanced Directive, as well as those created elsewhere, may be drafted by a licensed attorney as part of a comprehensive estate plan. In some jurisdictions, a default statutory AMD may be publicly available, whether online or through an institution such as a community center or nursing home. The AMD provides an individual with the opportunity to nominate a healthcare agent who will make healthcare decisions when that individual loses capacity and is unable to make such decisions. The document typically contains instructions for the healthcare agent(s) as to the extent of medical treatment that the individual wishes to receive in certain situations.

Is the MOLST form or AMD better for me?

Oftentimes, the most difficult decisions clients have to make in drafting or updating estate planning documents are their healthcare decisions. Decisions made under these healthcare documents may be irreversible, which underscores each decision’s importance and illustrates the reasons why medical providers require specific documentation before taking certain actions.

While these documents have many similarities, they are unique in effect. For that reason, the decision of whether to complete the MOLST or Advanced Directive should be among the least difficult decisions you face when doing healthcare planning. These documents are not mutually exclusive, which may encourage the completion of both, but care must be taken to ensure they are consistent. Regardless of whether you decide to complete either or both forms, it is important that you inform your healthcare agents and family members of your preferences for treatment.

Understand the key differences between MOLST and AMD

Who is completing the document? While you are expressing your wishes in both, your AMD will be executed by you, individually, and your MOLST form will be completed and signed most likely by your doctor.
Accordingly, consulting with both your current doctor or nurse practitioner and/or lawyer can assist you in obtaining the necessary information for completing these documents.
When is the document effective? The MOLST is an actionable doctor’s order that is effective immediately. Conversely, the AMD typically does not go into effect until such time that you are unable to make informed medical decisions on your own behalf. Together, they create a continuum to document the healthcare decisions you want made on your behalf.

What is the purpose of each document? Oftentimes, the MOLST will serve as an expression of your wishes for current medical treatments while you still have capacity. Completing a MOLST form with your medical professional in advance of a crisis, while you are in a calm state of mind, can assist you in documenting the choices you want made. In contrast, the AMD is a guide to express to your healthcare agent(s) the choices you want in the event you are unable to make decisions for yourself in the future. Thus, the MOLST and AMD have two distinct triggering points that may encourage the completion of both.

Conclusion

A word of caution for those individuals completing both the MOLST and AMD documents: Consistency between the expressions under these documents is paramount. While the decisions under the MOLST and AMD may not overlap, any conflict between the decisions they express may have unforeseen consequences in the future. If a conflict should arise, the MOLST form takes precedence.

If you have any questions or concerns about the MOLST form or AMD documents or any of your estate planning documents or matters, please contact one of the attorneys in our estate planning department at 301-340-2020.


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