Most state are moving progressively toward clearer and stronger authority for their POLST programs. Oddly, a few days ago, the Director of the Delaware DHSS Division of Public Health formally asked "all healthcare providers to please discontinue use of the STATE OF DELAWARE MOLST form."
Actually, we in Delaware expect this to be a temporary measure. Our legislature (which re-convenes in January) will likely re-write Delaware's Health Care Decisions Act and its related regulations.
ReplyDeleteThe current Act governs advance directives and includes a requirement that "qualifying conditions" are met before an advance directive goes into effect. The MOLST/POLST, however, is not technically an advance directive, but is rather an actionable medical order. It goes into effect as soon as it's completed.
Delaware's Health Care Decisions Act does not include language broad enough to allow for use of a MOLST/POLST form. We expect the Legislature will remedy this discrepancy soon, and the MOLST will come back into use.
Sheila Grant
@Troublemaker: Thanks for the clarification. So it was simply a matter of the underlying verbiage in DE's HCDA not supporting the MOLST paradigm(?) Sounds like a relatively easy thing to fix.
ReplyDeleteMOLST/POLST/POST should not be limited to terminally ill patients inasmuch as non-terminal patients should also have the right to refuse or restrict future medical treatments.
There are potential problems with and misapplications of MOSLT/POLST but this shouldn't be one of them.
Ronn,
ReplyDeleteFixing statutory language is relatively easy in the sense that it just takes just a few words, just a few keystrokes. It's just language.
But getting the right people to vote on that language is often no easy matter. Many POLST bills failed this past legislative session around the country.
And the reason Delaware (like Minnesota and other states) did not pursue MOLST legislation in the first place is because of serious doubts about what, if anything, might emerge from the state legislature.
Thad
Dear Thaddeus,
ReplyDeleteCT has recently proposed MOLST but at least one group has raised DE's repeal as one of the reasons not to implement. Is there any update available on Delaware's repeal of MOLST: whether it's been reenacted, lessons learned, community involvement in the revised legislation, and so forth?
Thank you,
Lori Bruce
Executive Director, The Connecticut Coalition to Improve End-of-Life Care, Inc.
Assistant Director, Summer Institute in Bioethics, Yale University
Chair, Community Bioethics Forum, Yale School of Medicine
VP, Community Voices in Medical Ethics
Dear Thaddeus,
ReplyDeleteConnecticut has recently proposed MOLST, but at least one group has raised the repeal by DE as one of the reasons not to implement. Might there be an update on whether DE has revised & reissued MOLST, whether they have tracked their "lessons learned," and whether there was any community involvement in the revision process?
Thank you,
Lori Bruce
Executive Director, The Connecticut Coalition to Improve End-of-Life Care, Inc.
Assistant Director, Summer Institute in Bioethics, Yale University
Chair, Community Bioethics Forum, Yale School of Medicine
VP, Community Voices in Medical Ethics