End-of-Life Decisions for Alzheimer's Patients: Understanding the Role of the POLST/MOLST Form

Attorney RJ Connelly III

"Making end-of-life decisions can be one of the toughest challenges for those caring for someone with Alzheimer's disease," said professional fiduciary and certified elder law Attorney RJ Connelly III. "As the illness advances, patients often lose the ability to communicate their wishes regarding medical treatments and care preferences. This is where POLST (Physician Orders for Life-Sustaining Treatment) and MOLST (Medical Orders for Life-Sustaining Treatment) forms come into play."

These forms are essential tools for families and healthcare providers, ensuring that medical treatments reflect the individual's preferences, especially when clear communication is no longer an option. In this post, we will discuss the role of the POLST/MOLST form, why it is significant for individuals with Alzheimer's, and how it can streamline the decision-making process at the end of life.

Understanding the Form

POLST (Physician Orders for Life-Sustaining Treatment) and MOLST (Medical Orders for Life-Sustaining Treatment) are critical medical directives designed for individuals facing serious, often life-limiting illnesses, such as advanced Alzheimer's disease. These forms are instrumental in articulating a patient's preferences regarding medical interventions and treatments as they near the end of life.

POLST and MOLST serve the essential function of ensuring that healthcare providers honor the values and wishes of patients, thus facilitating care congruent with the individual’s desires. They provide clear, actionable medical orders that can guide decisions surrounding life-sustaining treatments, resuscitation efforts, and other critical care measures. Other highlights include:

Terminology: The Physician Orders for Life-Sustaining Treatment (POLST) form has gained widespread adoption across numerous states in the United States, serving as a vital tool for ensuring that patients' preferences for end-of-life care are honored. In contrast, the Medical Orders for Life-Sustaining Treatment (MOLST) form is utilized within multiple states and a few select regions, reflecting a more localized approach to advance care planning. This distinction highlights the varying frameworks and practices surrounding advance directives in different areas of the country. See below what forms are utilized in Southern New England:

-- Rhode Island

-- Connecticut

-- Massachusetts

Legal Standing: Both documents hold legal significance as formal medical orders, providing essential guidance in patient care. However, it's crucial to recognize that regulations governing these orders vary significantly from state to state. Therefore, ensuring compliance with local laws and requirements is vital to avoid potential legal complications and uphold the integrity of medical practices.

Specifications: POLST and MOLST forms empower patients to articulate their treatment preferences clearly and comprehensively. These documents ensure that individuals' healthcare decisions are honored, especially in critical situations. Remarkably, around 90% of those who engage in completing these forms take the opportunity to express their wishes about crucial medical interventions, such as resuscitation efforts, the use of mechanical ventilation, and the administration of artificial nutrition. This proactive approach reflects their values and priorities and fosters meaningful conversations between patients and healthcare providers.

Understanding the role of the POLST/MOLST form is crucial for ensuring medical care aligns with the wishes of individuals living with Alzheimer's disease.

MOLST/POLST and Alzheimer's

As Alzheimer's disease advances, individuals often face growing challenges in expressing their healthcare preferences. This deterioration in communication underscores the importance of POLST/MOLST forms. These documents play a vital role in meticulously recording a patient’s wishes regarding medical treatment. This ensures that healthcare providers honor and adhere to those preferences, even when the patient can no longer articulate them. With these forms in place, patients can receive care that aligns with their values and desires during their most vulnerable moments.

MOLST/POLST Alleviates Burdens on Families

Making end-of-life decisions can be an incredibly daunting experience, particularly when a cherished family member cannot express their wishes. A comprehensive study revealed that a significant 70% of families found solace in having their loved one's preferences formally documented. This is where POLST/MOLST forms come into play, simplifying an otherwise complex decision-making process. By providing clear guidelines, these forms allow families to concentrate on offering emotional support and compassion during profoundly challenging moments, empowering them to navigate this arduous journey with greater peace of mind.

Completing the POLST/MOLST for Healthcare Providers

Completing the POLST/MOLST form is a straightforward process, yet it requires careful attention as it must be filled out and signed by a qualified healthcare provider. This critical document ensures a patient’s healthcare preferences are communicated and respected. To navigate this process effectively, follow this thoughtful and straightforward guide:

Consult with Healthcare Providers: For the individual and family members, discuss your loved one's condition and prognosis with their healthcare provider. This conversation provides crucial insights into the types of treatments that may be appropriate.

Discuss Preferences: For healthcare providers, engage in honest discussions with the Individual. Talk about their values and preferences regarding medical interventions, such as whether they want resuscitation attempts in specific situations.

Complete the Form: Healthcare providers, with direction from the individual and the family, should fill out the form with the patient's specific preferences. Be detailed and precise on resuscitation orders, mechanical ventilation, and nutrition options.

Sign the Form: The patient (or their designated decision-maker) and the healthcare provider must sign the POLST/MOLST form to bind it legally.

Distribute Copies: Ensure copies are given to family members, caregivers, and healthcare providers. This ensures that everyone involved in the individual’s care understands their wishes.

Review and Update Regularly: As Alzheimer’s disease progresses, the individual’s preferences may change. Regularly reviewing and updating the POLST/MOLST form with the individual and the family is essential to reflect any shifts in treatment desires.

POLST/MOLST is Not Required: Patients are not required to complete one of these forms.

Challenges and Considerations

While POLST /MOLST forms provide numerous advantages in guiding end-of-life care, they are not without their challenges. Implementing these forms can sometimes confuse patients, families, and healthcare providers regarding the desired medical interventions. Additionally, specific populations may lack awareness or understanding of these documents, hindering effective communication and decision-making. Moreover, these directives' legal and ethical implications can complicate situations, especially when family members have differing opinions on the treatment preferences outlined. While POLST and MOLST serve vital roles in ensuring patient autonomy and care alignment, navigating their complexities requires careful consideration and collaboration among all parties involved.

A Final Note

"POLST and MOLST forms play an essential role in honoring the end-of-life wishes of individuals with Alzheimer’s disease," stated Attorney Connelly. "By clearly outlining preferences, these forms provide valuable guidance for healthcare professionals, reducing uncertainty and fostering better communication among caregivers. This allows families to focus on what truly matters—being present for their loved ones during a profoundly challenging time. While navigating end-of-life decisions can feel daunting, understanding and utilizing POLST and MOLST forms can offer significant support to patients and their families. It’s important to take steps to ensure that your loved ones receive a dignified and compassionate end-of-life experience."

The information presented within this blog is intended exclusively for general informational purposes and should not be construed as legal, financial, or healthcare advice. The content, materials, and insights provided may not reflect the most recent developments in these fields and, therefore, should not be relied upon for personal or professional decisions. Further, this blog may contain links to various third-party websites, which are included solely for the convenience of our readers. It is essential to note that Connelly Law Offices, Ltd. does not automatically endorse or recommend the contents of these external sites. Given the complexities and nuances associated with legal, financial, or healthcare matters, we strongly encourage individuals to consult a qualified attorney, a professional fiduciary advisor, or a healthcare provider regarding any specific issues or concerns. Your well-being and informed decision-making are of paramount importance to us.