Forms for End-of-Life Care
Our seniors face a crisis of ignorance that could be life-threatening. The staff at senior living facilities likely don’t understand the forms that direct end-of-life care. In my experience, neither do the people who authorize or execute these forms.
The MOLST, a DNR, and a Living Will documents are intended to guide care in serious or life-threatening situations. They are not meant to block ordinary medical treatment for common, treatable illnesses such as the flu or mild pneumonia. When used well, these forms help everyone stay calm, communicate clearly, and remain aligned with the person’s values, while still treating medical problems that are likely to improve.
MOLST
A MOLST, or Medical Orders for Life-Sustaining Treatment, is a medical order. It tells clinicians which life-sustaining treatments to use or avoid. The form addresses issues such as CPR, intubation, feeding tubes, hospitalization, and intensive care. Unlike a general statement of wishes, a MOLST can both accept and refuse specific treatments. The form travels with the person across care settings, including at home, in facilities, and with emergency medical services.
DNR
A DNR is much narrower in scope. It simply means that if the person’s heart or breathing stops, CPR should not be attempted. A DNR does not mean “do not treat,” and it does not prohibit antibiotics, oxygen, fluids, or comfort care. People are often surprised to learn that a DNR is quite limited.
Living Will
A Living Will is a legal document that explains what kinds of medical treatment a person would or would not want if they cannot speak for themselves. It usually applies to situations involving terminal illness or permanent unconsciousness. Rather than serving as a real-time medical order, it provides guidance for clinicians and family members when difficult decisions must be made.
Ill But Not Dying
When the illness itself is not immediately life-threatening, the usual approach is to treat the illness. These documents would not say otherwise. This generally means providing standard care like antibiotics, fluids, oxygen, and medications to relieve discomfort. In these situations, the MOLST and Living Will are best used as guides for how aggressive care should be if the person’s condition worsens, rather than as reasons to withhold reasonable, low-burden treatment.
When an older person becomes ill, it helps to bring copies of the MOLST, DNR, and Living Will to the medical visit or hospital so the care team can review the actual language. Families often find it useful to ask straightforward questions, such as whether a DNR still allows antibiotics, oxygen, or a short hospital stay if needed, or how far the team should go if the illness progresses. For example, these documents guide whether decisions about intensive care, a breathing machine, or CPR would be consistent with the person’s wishes.
Decision Making Continues
If the person is still able to make decisions, all caretakers, family, and medical staff alike should take the time to confirm with the patient their understanding and intentions. These documents are not frozen in time. They can be revised whenever circumstances, health, or priorities shift. Most importantly, they should not be understood as a wish to die. A serious illness sometimes clarifies what matters most, such as a desire to avoid repeated hospitalizations and focus instead on comfort and time at home.
Used this way, MOLST, DNR, and Living Will forms do exactly what they are meant to do. They protect older adults from unwanted, extreme measures while still allowing compassionate, appropriate treatment for everyday illnesses, and they give families and clinicians a shared framework for making thoughtful, respectful decisions.
Evan J. Krame
