Medical Orders for Life-Sustaining Treatment (MOLST) Glossary

"1750-b"

means New York's Health Care Decisions Act for People With Developmental Disabilities (NY SCPA § 1750-b), which establishes the authority of certain designated parties to make health care decisions for a patient with an intellectual or developmental disability in cases where the patient lacks decisional capacity and does not have a health care proxy. This "surrogate" decision-maker would also be empowered to direct the withdrawal or withholding of life-sustaining treatment when standards set forth in the statute are satisfied.

"Adult"

means any person 18 or older or any person who has married.

"Clear and convincing evidence"

is evidence that the patient held a firm and settled commitment to the withholding of life-sustaining treatment in the event of circumstances like the patient's current medical condition. The evidence may be in a written living will, and/or previous oral statements indicating the patient's wishes, considering the circumstances under which such statements were made and to whom. In order to decide whether the evidence of the patient's wishes is clear and convincing, consideration should be given to:

• whether the statements were general or specific;
• whether the statements were about specific circumstances (for example, terminal illness, persistent vegetative state) that are similar to the patient's current medical condition;
• the intensity, frequency, consistency, and seriousness of such statements;
• whether the statements tended to show that the patient held a firm and settled commitment to certain treatment decisions under circumstances like those presented;
• whether the strength and durability of the patient's religious and moral beliefs make a more recent change of heart unlikely; and
• whether the statements were made to one person only or to more than one person close to the patient.

"Close friend"

is any person 18 or older who is a friend or relative of the patient. This person must have maintained regular contact with the patient; be familiar with the patient's activities, health, and religious or moral beliefs; and present a signed statement to that effect to the attending doctor, nurse practitioner, or physician assistant.

"Community"

means not in a hospital, hospice, or nursing home.

"Domestic partner"

means a person who:

• has entered into a formal domestic partnership recognized by a local, state, or national government; or
• has registered as a domestic partner with a registry maintained by the government or an employer; or
• is covered as a domestic partner under the same employment benefits or health insurance; or
• shares a mutual intent to be a domestic partner with the patient, considering all the facts and circumstances, such as:
  • They live together.
  • They depend on each other for support.
  • They share ownership (or a lease) of their home or other property.
  • They share income or expenses.
  • They are raising children together.
  • They plan on getting married or becoming formal domestic partners.
  • They have been together for a long time.

The following may not be a "domestic partner:"

• A parent, grandparent, child, grandchild, brother, sister, uncle, aunt, nephew or niece of the patient or the patient's spouse.
• A person who is younger than 18.

"FHCDA"

means New York's Family Health Care Decisions Act (FHCDA) (NY PHL Article 29-CC effective June 1, 2010), which establishes the authority of a patient's family member or close friend to make health care decisions for the patient in cases where the patient lacks decisional capacity and did not leave prior instructions or appoint a health care agent. This "surrogate" decision-maker would also be empowered to direct the withdrawal or withholding of life-sustaining treatment when standards set forth in the statute are satisfied.

"Health or social service practitioner"

means a registered professional nurse, nurse practitioner, physician, physician assistant, psychologist, or licensed clinical social worker, licensed or certified pursuant to the Education Law and acting within his or her scope of practice. A health or social service practitioner who determines that a patient lacks medical decision-making capacity must be competent to do so, based on his/her experience and training.

"Hospital"

means a general hospital as defined in subdivision ten of section twenty-eight hundred one of the Public Health Law and section 1.03 of the Mental Hygiene Law; or a hospice as defined in Public Health Law Article 40, without regard to where the hospice care is provided.

"Life-sustaining treatment"

means any medical treatment or procedure without which the patient will die within a relatively short time, as determined by an attending physician, nurse practitioner, or physician assistant to a reasonable degree of medical certainty. Cardiopulmonary resuscitation (CPR) is presumed to be life-sustaining treatment without the necessity of a determination by an attending physician, nurse practitioner, or physician assistant.

"Mental hygiene facility"

means, for purposes of these checklists, a facility operated or licensed by the Office of Mental Health (OMH) or the Office for People With Developmental Disabilities (OPWDD) as defined in subdivision six of section 1.03 of the Mental Hygiene Law; i.e., any place in which services for the mentally disabled are provided and includes, but is not limited to, a psychiatric center, developmental center, institute, clinic, ward, institution or building, including a community residence operated by or subject to licensure by OMH or OPWDD under section 1.03(28).

"Nurse practitioner"

means a licensed nurse practitioner.

"Nursing home"

means a residential health care facility as defined in subdivision three of section twenty-eight hundred one of the Public Health Law.

"Physician"

means a licensed physician.

"Physician assistant"

means a licensed physician assistant.

"Qualified psychiatrist"

means a physician licensed to practice medicine in New York State, who is a diplomate or eligible to be certified by the American Board of Psychiatry and Neurology or who is certified by the American Osteopathic Board of Neurology and Psychiatry or is eligible to be certified by that board.

"Reasonably available"

means that a person to be contacted, can be contacted with diligent efforts by an attending physician, nurse practitioner, or physician assistant, another person acting on behalf of an attending physician, nurse practitioner, or physician assistant, or the hospital or nursing home.