{"id":1731,"date":"2016-04-01T21:01:23","date_gmt":"2016-04-01T21:01:23","guid":{"rendered":"http:\/\/tvndy.ca\/?p=1731\/"},"modified":"2018-11-06T18:47:22","modified_gmt":"2018-11-06T18:47:22","slug":"webcast-archive-medical-orders-for-life-sustaining-treatment","status":"publish","type":"post","link":"https:\/\/tvndy.ca\/en\/2016\/04\/webcast-archive-medical-orders-for-life-sustaining-treatment\/","title":{"rendered":"Webcast archive: Medical Orders for Life Sustaining Treatment"},"content":{"rendered":"<p><iframe loading=\"lazy\" width=\"1180\" height=\"664\" src=\"https:\/\/www.youtube.com\/embed\/qvpybmi-V1I?feature=oembed\" frameborder=\"0\" allow=\"accelerometer; autoplay; encrypted-media; gyroscope; picture-in-picture\" allowfullscreen><\/iframe><\/p>\n<p>In this episode of <em>Euthanasia &amp; Disability<\/em>, Amy Hasbrouck and Christian Debray discuss\u00a0Medical Orders for Life Sustaining Treatment.<\/p>\n<p>Please note that this text is only a script and that our webcast contains additional commentary.<\/p>\n<p><strong>MEDICAL ORDERS FOR LIFE SUSTAINING TREATMENT<\/strong><\/p>\n<ul>\n<li>Advance care planning is a good idea in general.\u00a0 It\u2019s important to have conversations with your loved ones and your doctor about what medical treatments you would or would not want should you become unable to direct your own care.\u00a0 And it\u2019s important to name a person to carry out your wishes if you are unconscious.<\/li>\n<li>One tool used in advance care planning is called a Physician Order for Life Sustaining Treatment (POLST), or a Medical Order for Life Sustaining Treatment, (MOLST)<\/li>\n<li>A \u201cDo Not Resuscitate\u201d order is a kind of MOLST.<\/li>\n<li>Unlike an advance directive, which is a request made by a patient, a MOLST is signed by a doctor, and has the effect of a medical order.<\/li>\n<li>A doctor is supposed to discuss the options with a person who has a terminal illness, help her fill out the form, witness her signature, then sign it, attesting that the discussion took place.\u00a0 The form is then put into the person\u2019s medical record, and should be followed by staff if the person cannot consent to care.<\/li>\n<li>Unfortunately it doesn\u2019t always work out that way.<\/li>\n<li>Doctors and hospitals often use MOLST with disabled people with non-terminal illness.\u00a0 Most people who are terminally ill have a disability, but many people with disabilities are not terminally ill.<\/li>\n<li>When deciding whether or not to fill out a MOLST form, a doctor will usually answer the \u201csurprise question\u201d:\u00a0 would she be surprised if the person died within the next year.\u00a0 This is not a an official diagnosis, nor a terminal prognosis, and can include many people whose lives are not at risk.<\/li>\n<li>Yet some state laws even extend MOLST to people with a five-year prognosis.<\/li>\n<li>Filling out a MOLST is often presented to patients as mandatory, though it is not.\u00a0 People who refuse may be pressured to do so.<\/li>\n<li>Many MOLST forms require a simple \u201cyes\u201d or \u201cno\u201d answer to proposed treatments, but without any context.\u00a0 So to the question \u201cwould you accept a feeding tube?\u201d the answer might depend on factors that are not listed on the form.<\/li>\n<li>Also, the form might not specify what medical treatments are included in \u201ccomfort care\u201d or \u201cintermediate care.\u201d<\/li>\n<li>Another problem with MOLST is its bias against life-sustaining technologies.\u00a0 Interventions such as feeding tubes and tracheotomies are presented as negative, intrusive, limiting, and incompatible with a normal life.\u00a0 Presented with such biased information, most people refuse these options, though many disabled people are able to pursue fulfilling and productive lives thanks to these technologies.<\/li>\n<li>The completed MOLST form may not reflect the person\u2019s wishes, the person must trust the doctor will resist the pressure to cut costs and honour his requests.\u00a0 Laws allow doctors to overrule a person\u2019s request for life-sustaining treatment if she thinks care would be \u201cfutile.\u201d\u00a0 Some of the worst of these abuses happen in nursing homes.\n<ul>\n<li>Some forms don\u2019t require the patient\u2019s signature, or the doctor may just sign the form and put it in the person\u2019s record.<\/li>\n<li>Many MOLST forms are filled out by nurses or nurses\u2019 aides, and may even lack a doctor\u2019s signature.<\/li>\n<li>Sometimes forms are changed after the person signs it.<\/li>\n<li>One such form provided that anyone could sign to make medical decisions for the person in case of incapacity.<\/li>\n<li>Sometimes nursing home staff ask family members to sign MOLST forms even though the person has capacity to make his own medical decisions.<\/li>\n<li>The MOLST form may be explained by a non-medical staff person, such as an admissions coordinator or a business manager leading to a lack of informed consent.<\/li>\n<\/ul>\n<\/li>\n<li>Some doctors and nurses follow the instructions only when they agree with the MOLST.\u00a0 So if the form calls for breathing support but the medical staff think it\u2019s futile, they may simply ignore the order.<\/li>\n<li>Also, there is a risk of over-interpretation of the MOLST.\u00a0 In one study, over 50% of medical staff misinterpreted a MOLST as including a DNR when it didn\u2019t.<\/li>\n<li>The form should be in both official languages to be understood by the person and medical staff.<\/li>\n<li>There may be confusion and conflict between an advance directive (which comes from the person) and a MOLST, which comes from the doctor, has the authority of a medical order and is more likely to be followed by staff.<\/li>\n<li>The MOLST stays in effect until it is removed, and revocation can be difficult.\u00a0 In one study in of five cases in Manitoba, two people who tried to have a DNR order removed from their loved ones\u2019 charts were refused and harassed, while another person was pressured to accept a DNR order.<\/li>\n<li>There may be problems with the physician order signed by a doctor at one institution being honoured by medical staff at another hospital.<\/li>\n<li>It\u2019s important that patients and their families be vigilant in checking to see what is written on a MOLST, and demanding that it be changed if it doesn\u2019t agree with their wishes.<\/li>\n<\/ul>\n   ","protected":false},"excerpt":{"rendered":"<div class=\"entry-summary\">\n<div class=\"entry-summary\">\nToday, we discuss problems with Medical Orders for Life-Sustaining Treatment and other advance directives.\n<\/div>\n<div class=\"link-more\"><a href=\"https:\/\/tvndy.ca\/en\/2016\/04\/webcast-archive-medical-orders-for-life-sustaining-treatment\/\" class=\"more-link\">Continue reading<span class=\"screen-reader-text\"> &ldquo;Webcast archive: Medical Orders for Life Sustaining Treatment&rdquo;<\/span>&hellip;<\/a><\/div>\n<\/div>\n<div class=\"link-more\"><a href=\"https:\/\/tvndy.ca\/en\/2016\/04\/webcast-archive-medical-orders-for-life-sustaining-treatment\/\" class=\"more-link\">Continue reading<span class=\"screen-reader-text\"> &ldquo;Webcast archive: Medical Orders for Life Sustaining Treatment&rdquo;<\/span>&hellip;<\/a><\/div>\n","protected":false},"author":2,"featured_media":0,"comment_status":"closed","ping_status":"closed","sticky":false,"template":"","format":"standard","meta":{"footnotes":""},"categories":[92],"tags":[349,121,348,118],"class_list":["post-1731","post","type-post","status-publish","format-standard","hentry","category-webcast-archive","tag-dnr","tag-euthanasia-disability","tag-molst","tag-webcast","entry"],"_links":{"self":[{"href":"https:\/\/tvndy.ca\/en\/wp-json\/wp\/v2\/posts\/1731","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/tvndy.ca\/en\/wp-json\/wp\/v2\/posts"}],"about":[{"href":"https:\/\/tvndy.ca\/en\/wp-json\/wp\/v2\/types\/post"}],"author":[{"embeddable":true,"href":"https:\/\/tvndy.ca\/en\/wp-json\/wp\/v2\/users\/2"}],"replies":[{"embeddable":true,"href":"https:\/\/tvndy.ca\/en\/wp-json\/wp\/v2\/comments?post=1731"}],"version-history":[{"count":5,"href":"https:\/\/tvndy.ca\/en\/wp-json\/wp\/v2\/posts\/1731\/revisions"}],"predecessor-version":[{"id":3713,"href":"https:\/\/tvndy.ca\/en\/wp-json\/wp\/v2\/posts\/1731\/revisions\/3713"}],"wp:attachment":[{"href":"https:\/\/tvndy.ca\/en\/wp-json\/wp\/v2\/media?parent=1731"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"https:\/\/tvndy.ca\/en\/wp-json\/wp\/v2\/categories?post=1731"},{"taxonomy":"post_tag","embeddable":true,"href":"https:\/\/tvndy.ca\/en\/wp-json\/wp\/v2\/tags?post=1731"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}