DPH proposal to let 'voluntary conservators' sign MOLST prompts debate over safeguards and probate limits

The Department of Public Health presented a legislative draft on Feb. 3 that would add "voluntary conservators" to the definition of legally authorized representative for executing medical orders for life‑sustaining treatment (MOLST), prompting an extended discussion about verification, statutory limits and patient protections.

Barbara Cass, senior advisor to the commissioner of the Department of Public Health for Long Term Care, said DPH's proposal grew from an internal review and would explicitly add voluntary conservators to the LAR definition so they could sign a MOLST on behalf of a patient who had designated them. "Our legislative proposed proposal includes adding voluntary conservators to the definition of a legally authorized representative," she said.

Supporters said the change could help patients who have named a trusted conservator but not a separate health care representative; critics said the proposal risks including court‑appointed or professional conservators who may lack knowledge of a patient's values. "There are several concerns about court‑appointed conservators," said Jim, a long‑standing advisory member with legal experience. He noted that professional conservators, whom probate courts sometimes appoint, might never have discussed end‑of‑life values with the person they represent.

Clinicians raised questions about how staff would distinguish voluntary from involuntary conservators at the bedside. Several speakers said probate appointment paperwork typically records whether a conservator was voluntarily designated, and that social work or clinician teams could validate documentation, but others worried that differentiating conservator types would be impractical in many settings. "I just don't see any nursing home delving this deeply into any of this," one clinician said, warning that extra verification steps could become a barrier to care.

Members discussed alternatives to expanding MOLST eligibility. Doctor Shapiro and others urged caution about creating a separate "MOLST‑light" form, saying a third portable order could confuse clinicians and the public. Instead, some recommended revising the separate outpatient DNR program or developing a distinct, simpler portable order while keeping MOLST's core purpose intact. "Introducing a third option where it's the MOLST light would be confusing," Doctor Shapiro said.

DPH and several clinicians emphasized existing statutory protections. Speakers noted physicians can rely on documented patient preferences in medical records when making treatment decisions, but a patient who lacks capacity generally cannot execute a MOLST themselves; a recognized legally authorized representative is required under current statute. Adam, DPH's legislative liaison, said the draft is intentionally focused on "voluntary" conservators — those the patient chose — not involuntary or court‑appointed conservators.

The council did not vote on the proposal. Members asked DPH to refine statutory language and to add operational safeguards — for example, clarifying the hierarchy between health care representatives and conservators, specifying documentation acceptable at point of care, and coordinating with probate stakeholders. Barbara Cass said DPH would take the committee's feedback back for internal discussions and work with other stakeholders before finalizing language for the legislative session that begins the following day.

Malia, a DPH staff member who oversees training, told the council that training sessions and recordings are progressing and that a planned MOLST 2 rollout is targeted for June, though final edits may be delayed by legislative work.

The advisory council closed without a formal vote on the draft proposal. DPH said it would revise the draft language and return with clarified policy recommendations and implementation steps for further review.