§23-4.11-3.1  Medical orders for life sustaining treatment. –


Published: 2015

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TITLE 23

Health and Safety

CHAPTER 23-4.11

Rights of the Terminally Ill Act

SECTION 23-4.11-3.1



   § 23-4.11-3.1  Medical orders for life

sustaining treatment. –

(a) The department of health shall establish rules and regulations, consistent

with the provisions of this section, for the establishment of Medical Orders

for Life Sustaining Treatment and the structure and content of Medical Orders

for Life Sustaining Treatment forms.



   (b)(1) A declaration by a qualified patient may be recorded

as a medical order for life-sustaining treatment provided that:



   (i) The medical orders for life-sustaining treatment and

medical intervention and procedures are explained by a MOLST qualified health

care provider to the qualified patient or health care decision maker. The MOLST

qualified health care provider shall further inform the patient of the

difference between an advance health care directive and MOLST medical order;



   (ii) A MOLST qualified health care provider has conducted an

evaluation of the qualified patient; and



   (iii) A MOLST form documenting the declaration has been

completed by a MOLST qualified health care provider based on qualified patient

preferences and medical appropriateness, and has been signed by a MOLST

qualified health care provider and the qualified patient or his or her

recognized health care decision maker.



   (2) A health care decision maker may execute the MOLST form

if the qualified patient lacks capacity, or if the qualified patient has

designated that the health care decision maker's authority is valid.



   (3) A request regarding resuscitative measures may also be

evidenced by the words "do not resuscitate" or the letters "DNR," in a

qualified patient's medical record and/or through a mechanism established by

the department of health consistent with the provisions of chapter 23-4.11.



   (c)(1) A health care provider shall treat a qualified patient

in accordance with the qualified patient's MOLST, subject to the provisions of

this chapter.



   (2) A MOLST qualified health care provider may conduct an

evaluation of the qualified patient and if necessary, in consultation with the

qualified patient or recognized health care decision maker, issue a new MOLST

consistent with the most current information available about the qualified

patient's health status and care preferences.



   (3) The recognized health care decision maker of a qualified

patient who is without capacity shall consult with the MOLST qualified health

care provider prior to making a request to modify the qualified patient's MOLST.



   (d)(1) MOLST Form. A MOLST shall be documented on an

easily identifiable form approved by the director. The director shall

promulgate rules and regulations for the implementation of this section.



   (2) The MOLST form shall be signed by the qualified patient,

or the qualified patient's recognized health care decision maker, and a MOLST

qualified health care provider.



   (3) The MOLST form shall contain all other information as

required by this section.



   (e)(1) A MOLST shall apply regardless of whether the

qualified patient executes the MOLST form within or outside a hospital or other

health care setting.



   (2) The MOLST form is valid within or outside a hospital or

other health care setting.



   (f)(1) Revocation. A qualified patient or his/her

recognized health care decision maker may, at any time, revoke in any manner

that communicates an intent to revoke his/her declaration by informing the

MOLST qualified health care providers, other health care providers, or any

member of the medical or nursing staff of the revocation of the declaration

concerning life-sustaining or resuscitative measures.



   (2) Any member of the medical or nursing staff informed of a

revocation shall immediately notify a MOLST qualified health care provider of

the revocation.



   (3) The MOLST qualified health care provider informed of a

revocation of MOLST made pursuant to this section shall immediately:



   (i) Record the revocation in the qualified patient's medical

record;



   (ii) Cancel any orders implementing the decision to withhold

or withdraw treatment; and



   (iii) Notify the health care providers and staff directly

responsible for the qualified patient's care of the revocation and any

cancellations.



   (4) If a decision to withhold or withdraw life-sustaining

treatment has been made by a recognized health care decision maker pursuant to

this section, and the MOLST qualified health care provider determines at any

time that the decision is no longer appropriate or authorized because the

qualified patient has regained decision-making capacity or because the

qualified patient's condition has otherwise improved, the MOLST qualified

health care provider shall immediately:



   (i) Include such determination in the qualified patient's

medical record;



   (ii) Cancel any orders or plans of care implementing the

decision to withhold or withdraw life-sustaining treatment;



   (iii) Notify the health care decision maker who made the

decision to withhold or withdraw treatment; and



   (iv) Notify the other health care providers, including the

medical and nursing staff directly responsible for the qualified patient's

care, of any cancelled MOLST orders or plans of care.



   (g) If a qualified patient with a MOLST order is transferred

from a hospital, a licensed health facility, or the community, the MOLST order

or plan shall remain effective until a MOLST qualified health care provider

first examines the transferred qualified patient, whereupon a MOLST qualified

health care provider shall issue appropriate orders to continue the prior order

or plan. Such orders may be issued without obtaining another consent to

withhold or withdraw life-sustaining treatment pursuant to this chapter.



   (h) The MOLST is a voluntary option for qualified

patients. No patient is required to elect a MOLST.



History of Section.

(P.L. 2012, ch. 187, § 2; P.L. 2012, ch. 199, § 2; P.L. 2013, ch.

501, § 4.)

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