Molst ppt for public
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  • A will says how you want to divide up your possessions and your financial assets after you die. A living will is intructions for the type of medical care you want while you are still alive.


  • 1.  
  • 2.
    • 88% say they want to die at home
    • 20% actually
    • die at home
    Source: Teno, JM et al. Family perspectives on end of life care at the last place of care. JAMA. 2004;291:88-93
  • 3.
    • It can be be VERY tough
  • 4.
    • Autonomy
  • 5.
    • Plan ahead
    • Have conversations with your loved ones
    • Write down your values and wishes
  • 6.
    • Living will
    • Power of Attorney for Health Care
      • (Durable Power of Attorney”)
    • Other written documentation of your wishes/values
    • Conversations with your loved ones
  • 7.
    • Living Wills (state specific)
    • POA for Health Care (usually part of LW)
    • Other documentation of your values and wishes (see ABA toolkit, Caring Conversations, Five Wishes)
    • MOLST form (?)
  • 8.
    • Will
    • Living Will
  • 9.
    • May address:
    • Resuscitation (CPR)
    • Ventilator
    • Artificial Nutrition & Hydration
    • Antibiotics
    • Transfusions
    • Dialysis
    • Invasive Procedures
    • Organ Donation
    • ***May instruct YES or NO
  • 10.
    • Allows you to name someone to make decisions for you, if you are unable to make them yourself
      • Doesn’t take effect UNTIL you are unable (“springing”)
      • Usually has space for 2 decision-makers, in case one is unavailable
      • Pick the right person
        • Knows your wishes
        • Strong advocate
        • Available, willing
  • 11.
    • Can act for you ONLY if you are UNABLE TO MAKE DECISIONS for yourself.
    • MUST make decisions IN AGREEMENT WITH YOUR DESIRES as stated in your Living Will or as otherwise known to the agent.
    • If your wishes are unknown, they must make decisions “in the patient’s best interest”
  • 12.
    • You do NOT need an attorney
    • You do NOT need a notary in DE/PA/NJ/MD
    • You DO need two witnesses, not related to you, who will not inherit from you, who don’t work for the facility where you live.
    • Make copies and distribute
      • Family
      • Physician
      • POA’s
      • Keep several copies yourself and take to hospital or facility if you go
      • Copies have the same force as an original
  • 13.
    • Each state has a hierarchy of decision makers. In Delaware—
    • Spouse
    • Adult Child
    • Parent
    • Adult Sibling
    • Adult Grandchild
    • Adult Niece or Nephew
    • Guardian: Adult who has exhibited special care and concern—IF none of above are available AND if appointed by the court.
  • 14.
    • DE
    • PA
    • NJ
    • MD
    • If you do more than 1, make sure they all agree
  • 15.
    • Living Will
    • Only when a patient is terminally ill or in a persistent vegetative state
    • Medical POA
    • Whenever a patient is incapable of making or communicating a choice.
  • 16.
    • On a scale of 1 to 5, where do you fall on this continuum?
    • If there were a choice, would you prefer to die at home, or in a hospital?
    • Could a loved one correctly describe how you’d like to be treated in the case of a terminal illness?
    • Is there someone you trust whom you’ve appointed to advocate on your behalf when the time is near?
    • Have you completed any of the following: written a living will, appointed a healthcare power of attorney, or completed an advanced directive?
    engage with grace .org The One Slide Project 1 2 3 4 5 Don't give up on me no matter what, try any proven and unproven intervention possible Let me die in my own bed, without any medical intervention
  • 17.
    • Family disagrees with LW
    • Not all family members are “ready to let go”
    • Physician feels “we have to do something”, and family goes along
    • Cannot find LW/have not talked about it
    • Living will is unclear in present situation.
  • 18.
    • PLEASE . . .
      • Think about your values and wishes for the end of life
      • Document
      • Have a conversation with your loved ones
    • It’s may be difficult now, but it will save bigger difficulties later
  • 19.
    • EMS Providers will honor a new form called
    • Medical Orders for Life Sustaining Treatment (or MOLST)
  • 20.
    • All adults are encouraged to complete a living will and power of attorney.
    • MOLST—only for people with a terminal illness who do not want to be resuscitated in an emergency.
    • MOLST—intended to be used in the last year of life.