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.)
