Maryland law tries to help people who want to plan for medical situations when they might not be able to speak for themselves. The law also encourages health care professionals to give the best possible care to people with advanced illness. This page offers resources about Maryland's Health Care Decisions Act and related law. It also includes information about the Attorney General's initiatives and activities in other areas of Health Decisions Policy.
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1. The Medical Orders for Life-Sustaining Treatment (MOLST) form is a standard medical order form that travels with the patient and is designed to carry out a patient's treatment wishes regarding their current medical condition. The Attorney General's Office has worked closely with the Department of Health, the State Advisory Council on Quality Care at the End of Life, and the Maryland Institute for Emergency Medical Services Systems to help develop a MOLST form. Although not an advance directive, the MOLST form allows a patient a complete range of options for their care, from choosing all available life-sustaining treatments to limiting or refusing those treatments. The MOLST form simplifies the process for health care providers and helps to avoid errors by creating one standardized form to be used across health care settings.
The MOLST form is modeled on the Physician's Orders for Life-Sustaining Treatment (POLST) form in use in some states, which has been shown in studies to significantly increase the level of compliance with patients' wishes for their care at the end of life. It is hoped that the MOLST form will have the same positive impact in Maryland in helping to ensure that patients' wishes for their care are honored.
The Attorney General's Office will continue to work with other state agencies to provide training regarding the use of the MOLST form. In consultation with the Attorney General's Office, the State Advisory Council on Quality Care at the End of Life, and the Maryland Institute for Emergency Medical Services Systems, the Department of Health has established a website, marylandmolst.org, with educational materials regarding the MOLST form and information on upcoming training programs.
2. At the request of the Maryland General Assembly's Senate Finance Committee and House Health and Government Operations Committee, the Attorney General's Counsel for Health Decisions Policy formed a workgroup to study and make recommendations related to end-of-life counseling and hospice care. The workgroup consisted of representatives from a wide variety of agencies, organizations, and points of view. The workgroup met monthly from July through December 2009, and agreed to common goals in improving the quality of end-of-life counseling and care at the end of life. The workgroup's findings and recommendations are contained in the Report on Hospice Care, Palliative Care and End of Life Counseling.
3. The Attorney General's Office has developed a wallet card that you can use to document the location of your Advance Health Care Directive.
4. Health care professionals and facilities, their legal counsel, and others interested in health care decision-making may wish to visit marylandadvancedirectives.com. This website is designed to give practical guidance to health care professionals and facilities in interpreting and implementing the laws regarding health care decisions by providing legal text, links to official opinions, informal guidance, forms, guidelines, tools, and references. While this website is an educational resource only and is not a substitute for obtaining legal advice, it contains information that can be considered as health care professionals and facilities make decisions about how they implement policies on health care decision-making.
5. The State Advisory Council on Quality Care at the End of Life and the Maryland Health Care Commission have issued a joint report on pediatric palliative care. The report, “Study of Health Care Services for Children with Life-Threatening Conditions," discusses the needs of these children, the current situation in Maryland, projects on pediatric palliative care in other states, and policy options.
6. The National Consensus Project for Quality Palliative Care has released revised Clinical Practice Guidelines for Quality Palliative Care, 4th Edition. The guidelines expand on the eight domains of palliative care in the 3rd edition, and include clinical and organizational strategies, screening and assessment elements, practice examples, tools, and resources. The 4th edition creates a blueprint for excellence by establishing a comprehensive foundation for gold-standard palliative care for all people living with serious illness, regardless of their diagnosis, prognosis, age, or setting.
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