{"id":1738,"date":"2016-04-08T21:09:02","date_gmt":"2016-04-08T21:09:02","guid":{"rendered":"http:\/\/tvndy.ca\/?p=1738\/"},"modified":"2019-03-25T19:02:11","modified_gmt":"2019-03-25T19:02:11","slug":"webcast-archive-molst-part-ii-filling-out-the-forms","status":"publish","type":"post","link":"https:\/\/tvndy.ca\/en\/2016\/04\/webcast-archive-molst-part-ii-filling-out-the-forms\/","title":{"rendered":"Webcast archive: MOLST &#8211; Part II &#8211; Filling out the forms"},"content":{"rendered":"<p><iframe loading=\"lazy\" width=\"1180\" height=\"664\" src=\"https:\/\/www.youtube.com\/embed\/1qBmubvZxX8?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:<\/p>\n<ul>\n<li>MOLST &#8211; Part II \u2013 Filling out the forms<\/li>\n<\/ul>\n<p>Please note that this text is only a script and that our webcast contains additional commentary.<\/p>\n<p><strong>MOLST &#8211; PART II \u2013 FILLING OUT THE FORMS<\/strong><\/p>\n<ul>\n<li>After our discussion of Medical Orders for Life Sustaining Treatment last week, we felt that something was still missing.\u00a0 We talked in general terms, but didn\u2019t look at any actual MOLST forms.<\/li>\n<li>So this week, we obtained several forms from the U.S. and Canada that represent a mix of MOLST and advance directive orders.\u00a0 That way we can go over exactly what questions are on the forms, and how the questions are asked.<\/li>\n<li>Qu\u00e9bec\u2019s and Ontario\u2019s forms were not available on the internet, though we did find a copy of a form used in nursing homes in Qu\u00e9bec.<\/li>\n<li>Though the forms are for \u201clife-sustaining treatment\u201d, many present the option of rejecting life-saving treatments first.<\/li>\n<li>Some of the forms offer the least to most life-saving care options in that order.\u00a0 For example, the Fraser Health form from British Columbia offers comfort care first, then moves up to critical care.<\/li>\n<li>Some of the forms talk about what the person doesn\u2019t want, while a few, such as form from the Regina-Qu\u2019Appelle region in Saskatchewan, is phrased in terms of what the person wants.<\/li>\n<li>Some forms offer life-saving treatment on a \u201ctrial basis.\u201d\u00a0 This means that all measures would be taken to revive a person, then could be withdrawn later if the person wants them stopped, if she does not appear to be responding to treatment, or her condition is getting worse.<\/li>\n<li>The CPR (cardiopulmonary resuscitation) option is usually the first item on the list.\u00a0 The New York and Massachusetts forms offer \u201cdo not resuscitate\u201d as the first option, but most others put \u201cattempt resuscitation\u201d first.<\/li>\n<li>Sometimes the option of \u201cno intubation\u201d is offered, so that instead of having a breathing tube in your throat, only a breathing mask that provides positive airway pressure would be used.\u00a0 This choice is available on the Fraser Health form, and several from the U.S.<\/li>\n<li>Most regions seem to have three levels of care\n<ul>\n<li><strong>Do everything<\/strong>, including CPR, cardiac defibrillation and intubation.<\/li>\n<li><strong>Elevated level of care<\/strong>, including some services, but not others.<\/li>\n<li><strong>Comfort care.<\/strong><\/li>\n<\/ul>\n<\/li>\n<li>The services that make up the higher levels of care include:\n<ul>\n<li>Transfer to hospital, which applies both for people in long-term care and at home.\u00a0 If the person does not want to be resuscitated and just wants to die at home, she can refuse to be taken to the hospital.<\/li>\n<li>\u201cArtificial\u201d nutrition is feeding a liquid diet through a tube that is either inserted into the oesophagus via the nose, or through a gastric tube surgically inserted directly into the stomach.\u00a0 Refusing artificial nutrition means the person will die of starvation within a few weeks, depending on her health.<\/li>\n<li>\u201cArtificial hydration\u201d is when fluids are given intravenously instead of by mouth.\u00a0 Refusing fluids means the person will die of dehydration within about 5-7 days.<\/li>\n<li>Transfusions and blood products are given if a person has lost blood or if there is something wrong with the blood.\u00a0 Refusing blood or blood products could cause death within a few hours or days, depending on the problem.<\/li>\n<li>Kidney dialysis is needed when the kidneys are not working properly.\u00a0 It cleans toxins and impurities from the blood that could poison a person if its not done every few days.\u00a0 Refusing dialysis would cause death in a matter of days to weeks, depending on the level of kidney function.<\/li>\n<li>Antibiotics are necessary to cure infections.\u00a0 Refusing antibiotics will only cause a problem if you have a bacterial infection such as a urinary tract infection, an infected bed sore, C-difficile, pneumonia or other hospital-borne bug, any of which could cause death if untreated.<\/li>\n<\/ul>\n<\/li>\n<li>What is available in the higher level of care is different in each region, so it\u2019s important to read the form carefully to know what services are available at each level of care.<\/li>\n<li>Comfort care is medical care and treatment provided with the primary goal of relieving pain and other symptoms, and reducing suffering.\u00a0 It includes:\n<ul>\n<li>Reasonable measures to offer food and fluids by mouth, including spoon feeding and liquids via a straw.<\/li>\n<li>Administering medications (by mouth or in some regions, by IV).<\/li>\n<li>Turning and positioning the person<\/li>\n<li>Caring for wounds.<\/li>\n<li>Providing oxygen and suctioning (if the windpipe becomes clogged with secretions)<\/li>\n<\/ul>\n<\/li>\n<li>As we said last week, a doctor is supposed to discuss these 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>And, as we said, it doesn\u2019t always work out that way.<\/li>\n<li>Also, when doctors are describing these treatments, they often put a negative spin on them.\u00a0 So, for example, instead of describing tube feeding as a medical technology that enables people to live normal lives, they may describe it in very medical terms that make it seem undignified.<\/li>\n<li>It\u2019s important to remember that doctors only see people when something goes wrong; at their worst, in the hospital.\u00a0 They don\u2019t see people, even people with feeding tubes or using ventilators living their everyday lives out in the community.<\/li>\n<li>One problem we found with the MOLST forms was that they were not specific or confusing as to what treatments were required for each level of care.\n<ul>\n<li>For example, on the Qu\u00e9bec form, level 2 care requires \u201cCorrection of any reversible deterioration using the resources available at the facility.\u00a0 Transfer to a hospital as needed.\u201d<\/li>\n<li>The Georgia form\u2019s \u201climited additional interventions\u201d includes \u201ccomfort measures and medical treatment, IV fluids and cardiac monitor as indicated.\u00a0 Does not include intubation or mechanical ventilation.\u00a0 Avoid intensive care.\u00a0 Transfer to hospital if indicated.\u201d\u00a0 This definition requires you to refer to the Comfort Care guidelines, then includes both Dos and Don\u2019ts<\/li>\n<\/ul>\n<\/li>\n<li>As we said last week, it\u2019s crucial that patients and their families be vigilant in checking to see if there is a DNR or MOLST form in their medical charts, verify what is written on the form, and demand 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\">\nThis week, we resume our discussion of Medical Orders for Life Sustaining Treatment.\n<\/div>\n<div class=\"link-more\"><a href=\"https:\/\/tvndy.ca\/en\/2016\/04\/webcast-archive-molst-part-ii-filling-out-the-forms\/\" class=\"more-link\">Continue reading<span class=\"screen-reader-text\"> &ldquo;Webcast archive: MOLST &#8211; Part II &#8211; Filling out the forms&rdquo;<\/span>&hellip;<\/a><\/div>\n<\/div>\n<div class=\"link-more\"><a href=\"https:\/\/tvndy.ca\/en\/2016\/04\/webcast-archive-molst-part-ii-filling-out-the-forms\/\" class=\"more-link\">Continue reading<span class=\"screen-reader-text\"> &ldquo;Webcast archive: MOLST &#8211; Part II &#8211; Filling out the forms&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":[350,349,121,348,118],"class_list":["post-1738","post","type-post","status-publish","format-standard","hentry","category-webcast-archive","tag-advance-directive","tag-dnr","tag-euthanasia-disability","tag-molst","tag-webcast","entry"],"_links":{"self":[{"href":"https:\/\/tvndy.ca\/en\/wp-json\/wp\/v2\/posts\/1738","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=1738"}],"version-history":[{"count":4,"href":"https:\/\/tvndy.ca\/en\/wp-json\/wp\/v2\/posts\/1738\/revisions"}],"predecessor-version":[{"id":4170,"href":"https:\/\/tvndy.ca\/en\/wp-json\/wp\/v2\/posts\/1738\/revisions\/4170"}],"wp:attachment":[{"href":"https:\/\/tvndy.ca\/en\/wp-json\/wp\/v2\/media?parent=1738"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"https:\/\/tvndy.ca\/en\/wp-json\/wp\/v2\/categories?post=1738"},{"taxonomy":"post_tag","embeddable":true,"href":"https:\/\/tvndy.ca\/en\/wp-json\/wp\/v2\/tags?post=1738"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}