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Clinician raises concern that MOLST CPR option appears to force 'full treatment'; council says form clarifications possible
Summary
During public comment a clinician said the MOLST form's CPR checkbox seems to require selecting 'full treatment,' which could unintentionally force broader interventions; DPH and council members said free-text qualifiers and non-regulatory form revisions could address the issue.
A public commenter at the MOLST advisory council virtual meeting raised a substantive concern about how the revised MOLST form links cardiopulmonary resuscitation (CPR) to the "full treatment" goals-of-care choice.
"So, basically, if you say that you want CPR, you're saying yes to everything," the commenter (Regina, speaker 9) said, adding that the paper form's printed free-text lines are too small to capture nuanced preferences.
Council members and staff pushed back on a literal reading of "full treatment." Barbara Jacobs, a nurse and bioethicist, said selecting a goals-of-care option does not remove clinicians' obligation to discuss individual preferences. "It means there would not be any limitations to treatment, but it doesn't mean you have to get all those treatments," Jacobs said.
Barbara Cass, senior adviser to the commissioner for long term care, acknowledged the concern and said the council should listen to feedback and consider form changes that do not require rulemaking. "We are moving forward with this MOLST form. But I think it's important for us to listen and process the feedback that we get," Cass said, adding that minor form revisions could be made provided they do not involve regulatory changes.
The council discussed options to reduce confusion: emphasizing the free-text qualifier on the form, producing a concise fact sheet that highlights what changed in MOLST 2.0, and reaching clinicians through associations and continuing-education channels. The facilitator said the council will collect additional feedback from eligible providers and consider form edits based on real-world use.
The exchange concluded with the council affirming it would process public comments and consider form revisions that clarify the relationship between CPR, intubation and other interventions without altering the underlying regulations. The meeting then moved to a motion to close.
Speakers quoted in this article are listed in the speaker whitelist for attribution.
