Our government’s main debt problem is that medical care costs are skyrocketing beyond the country’s ability to pay. The root cause of this problem is the horrendous expense associated with the final year of life. With our current entitlement system (third-party payment of medical care costs by Medicare or Medicaid) the government picks up the tab for the extraordinary medical expense associated with the final year of life. The government is directed by politicians, who are incapable of the collective decision for withdrawal of life support. No politician, political party or administration wants to be labeled as being in favor of death panels. This is not a Democrat vs. Republican issue. We have to turn the decision on withdrawal of life support back to the individual or his/her family; otherwise, there is not enough money in the world to pay for the extraordinary measures technology allows. Reining in the cost of Medicare/Medicaid for an aging population will only be possible if end-of-life decisions are made by individuals, not politicians.
Medical Orders for Life-Sustaining Treatment (MOLST)
Honoring patient preferences is a critical element in providing quality end-of-life care. To help physicians and other health care providers discuss and convey a patient's wishes regarding cardiopulmonary resuscitation (CPR) and other life-sustaining treatment, the Department of Health has approved a physician order form (DOH-5003), Medical Orders for Life-Sustaining Treatment (MOLST) , which can be used statewide by health care practitioners and facilities. MOLST is intended for patients with serious health conditions who: •Want to avoid or receive any or all life-sustaining treatment; •Reside in a long-term care facility or require long-term care services; and/or •Might die within the next year.
Completion of the MOLST begins with a conversation or a series of conversations between the patient, the patient's health care agent or surrogate, and a qualified, trained health care professional that defines the patient's goals for care, reviews possible treatment options on the entire MOLST form, and ensures shared, informed medical decision-making. Although the conversation(s) about goals and treatment options may be initiated by any qualified and trained health care professional, a licensed physician must always, at a minimum: (i) confer with the patient and/or the patient's health care agent or surrogate about the patient's diagnosis, prognosis, goals for care, treatment preferences, and consent by the appropriate decision-maker, and (ii) sign the orders derived from that discussion.
The MOLST form is one way of documenting a patient's treatment preferences concerning life-sustaining treatment – providers may choose to use other forms. However, under State law, the MOLST form is the only authorized form in New York State for documenting both nonhospital DNR and DNI orders. In addition, the form is beneficial to patients and providers as it provides specific medical orders and is recognized and used in a variety of health care settings.
In hospitals and nursing homes, the form may be used to issue any orders concerning life-sustaining treatment. In the community, the form may be used to issue nonhospital Do Not Resuscitate (DNR) and Do Not Intubate (DNI) orders, and in certain circumstances, orders concerning other life-sustaining treatment. The signed MOLST form should be transported with patients as they travel to different health care settings. The medical orders on the form need not be re-issued by the patient's new health care provider, but should be reviewed and may be revised by a physician, when the patient transitions to a different setting and when the patient's preferences and/or medical conditions change.
The Department updated the MOLST form in June of 2010 to make it more user-friendly and to align the form with the Family Health Care Decisions Act (FHCDA) and other provisions of Chapter 8 of the Laws of 2010 that went into effect on June 1, 2010.
In addition to the MOLST form itself, the Department has developed legal requirements checklists. These checklists are NOT intended for use with patients with developmental disabilities who lack medical decision-making capacity, or patients with mental illness in a mental hygiene facility. The checklists are intended to assist providers in satisfying the complex legal requirements associated with decisions concerning life-sustaining treatment for all other patients. They are guidance documents, and the use of these checklists is not mandatory. However, providers that do not use the checklists must use an alternative method for assuring that they adhere strictly to all legal requirements for completing the form, including requirements related to securing informed consent to the medical orders from the proper person, making the clinical judgments necessary to support orders withholding or withdrawing life sustaining treatment and, where applicable, securing ethics committee approval and witnesses to the consent.
The MOLST legal requirements checklists and general instructions for adult patients are: •MOLST Adult General Instructions and Glossary (12/1/10) (PDF, 77KB, 6pg.) •MOLST Checklist 1 - adult with capacity any setting (12/1/10) (PDF, 44KB, 2pg.) •MOLST Checklist 2 – adult with health care proxy any setting (12/1/10) (PDF, 66KB, 3pg.) •MOLST Checklist 3 - adult with FHCDA surrogate (12/1/10) (PDF, 59KB, 4pg.) •MOLST Checklist 4 - adult without FHCDA surrogate (12/1/10) (PDF, 58KB, 4pg.) •MOLST Checklist 5 - adult without capacity in the community (12/1/10) (PDF, 59KB, 4pg.)
The MOLST legal requirements checklist for minor patients is: •MOLST Checklist for Minor Patients and Glossary (12/1/10) (PDF, 78KB, 7pg.)
A Note Regarding Use of MOLST for Persons With Mental Illness or Developmental Disabilities Who Lack Decision-Making Capacity:
The MOLST form has been approved by the Office of Mental Health (OMH) and the Office for People with Developmental Disabilities (OPWDD) for use as a nonhospital DNR/DNI form for persons with developmental disabilities or persons with mental illness, including persons who are incapable of making their own health care decisions or who have a guardian of the person appointed pursuant to Article 81 of the Mental Hygiene Law or Article 17-A of the Surrogate's Court Procedure Act. The OPWDD approved checklist MUST be attached to the MOLST form, in order for the form to be used for persons with developmental disabilities who are incapable of making their own health care decisions or who have a guardian of the person appointed pursuant to Article 81 of the Mental Hygiene Law or Article 17-A of the Surrogate's Court Procedure Act. The OPWDD checklist can be found here. A checklist for persons with mental illness in mental hygiene facilities, who are incapable of making their own health care decisions or who have a guardian of the person appointed pursuant to Article 81 of the Mental Hygiene Law or Article 17-A of the Surrogate's Court Procedure Act, is under development.
The MOLST form should be printed on bright "pulsar" pink, heavy stock paper. Hard copies of the card stock pink form (with all four pages printed landscape/double-sided on a single 11" X 17" sheet folded in the middle) can be ordered using a form that can be downloaded from http://www.compassionandsupport.org/.
only you can decide when to quit
...you are a product of your environment, your environment is a product of your priorities, your priorities are a product of you......
The replacement of morality and conscience with law produces a deadly paradox.
STOP BEING GOOD DEMOCRATS---STOP BEING GOOD REPUBLICANS--START BEING GOOD AMERICANS
If life support technology is funded by the taxpayer through medicare and medicaid, then end of life decisions will be political. If as a society we so easily allowed the unwanted unborn life to be terminated, than as a society, I believe with this culture of death, America will agree that expensive treatment for the elderly and terminally ill will become a waste of resources and they will be left to die.
Once we justify terminating life by putting a price tag on it, there's no telling who will be the next group of humans that are expendable. Maybe the handicapped?
If life support technology is funded by the taxpayer through medicare and medicaid, then end of life decisions will be political. If as a society we so easily allowed the unwanted unborn life to be terminated, than as a society, I believe with this culture of death, America will agree that expensive treatment for the elderly and terminally ill will become a waste of resources and they will be left to die.
Once we justify terminating life by putting a price tag on it, there's no telling who will be the next group of humans that are expendable. Maybe the handicapped?
no kidding....that's why you DONT let the government rule EITHER WAY......IT'S NONE OF THE GOVERNMENTS BUSINESS......if you believe strongly in not having an abortion you dont have to...the government isn't going to come in and tell you that you are NOT allowed to have anymore children and they aren't going to come in and tell you that you cant have a certain treatment....dont even let them make it a definitive choice for you....
I know of a person who had 5 kids....they went to reapply for services and was told that if they had one more child they would be cut from services.. all 5 kids with different daddy's.....so if the government can make that choice they will make others when given an inch.... you see the government sucks at the nitty-gritty details of mental illness/personal issues etc.....so I think it is more of towing the line by one's social circle as their church family friends etc.....just like I dont think it's right for the lefties to take my money and willy-nilly hand it out....that's MY CHOICE TOO...not theirs
...you are a product of your environment, your environment is a product of your priorities, your priorities are a product of you......
The replacement of morality and conscience with law produces a deadly paradox.
STOP BEING GOOD DEMOCRATS---STOP BEING GOOD REPUBLICANS--START BEING GOOD AMERICANS
no kidding....that's why you DONT let the government rule EITHER WAY......IT'S NONE OF THE GOVERNMENTS BUSINESS......if you believe strongly in not having an abortion you dont have to...the government isn't going to come in and tell you that you are NOT allowed to have anymore children and they aren't going to come in and tell you that you cant have a certain treatment....dont even let them make it a definitive choice for you....
I know of a person who had 5 kids....they went to reapply for services and was told that if they had one more child they would be cut from services.. all 5 kids with different daddy's.....so if the government can make that choice they will make others when given an inch.... you see the government sucks at the nitty-gritty details of mental illness/personal issues etc.....so I think it is more of towing the line by one's social circle as their church family friends etc.....just like I dont think it's right for the lefties to take my money and willy-nilly hand it out....that's MY CHOICE TOO...not theirs
So if I'm caring for an elderly parent and acting health proxy, and the stress and inconvenience on my life, as well as the expense becomes too much to handle, can I neglect the medical care and cost necessary to sustain life? Or, as a society, do we allow the government to step in and save the life that is willfully being neglected?
After all, an aging parent is similar in an unwanted pregnancy in that i isn't your choice to have one. So is it fair to the children, since they have NO CHOICE but to be burdened withe an aging parent? How do you fix that problem?
So if I'm caring for an elderly parent and acting health proxy, and the stress and inconvenience on my life, as well as the expense becomes too much to handle, can I neglect the medical care and cost necessary to sustain life? Or, as a society, do we allow the government to step in and save the life that is willfully being neglected?
If you are the proxy you can make any choice that the person has written down and others as well.....that person has MADE you proxy.....if you have no proxy---the government will choose for you.....you may call it neglect, but if that person made you their voice, it is your responsibility to follow it....I know PLENTY of cases where the proxy was unable to follow through on the directions set forth by the patient which means the patient picked a poor proxy....some folks even have a disclaimer that only if this and only if that and only if my entire family agrees--which indicates the persons desire to pretty much live forever which is silly and unreasonable and their family is put between and fight...but, their choice.... so we follow it....alot of folks make proxys and living wills based on very general terms due to lack of understanding and the fact that medicine is not black and white and not a god... proxy's are used all the time and without understanding of what their duty is....HIPPA forms are signed by parents as proxy's to their children, but then we let the government step in to change the choices.....dont let the government in to the nitty-gritty it's ineffectual and inefficient and doesn't have a soul.....
...you are a product of your environment, your environment is a product of your priorities, your priorities are a product of you......
The replacement of morality and conscience with law produces a deadly paradox.
STOP BEING GOOD DEMOCRATS---STOP BEING GOOD REPUBLICANS--START BEING GOOD AMERICANS
If you are the proxy you can make any choice that the person has written down and others as well.....that person has MADE you proxy.....if you have no proxy---the government will choose for you.....you may call it neglect, but if that person made you their voice, it is your responsibility to follow it....I know PLENTY of cases where the proxy was unable to follow through on the directions set forth by the patient which means the patient picked a poor proxy....some folks even have a disclaimer that only if this and only if that and only if my entire family agrees--which indicates the persons desire to pretty much live forever which is silly and unreasonable and their family is put between and fight...but, their choice.... so we follow it....alot of folks make proxys and living wills based on very general terms due to lack of understanding and the fact that medicine is not black and white and not a god... proxy's are used all the time and without understanding of what their duty is....HIPPA forms are signed by parents as proxy's to their children, but then we let the government step in to change the choices.....dont let the government in to the nitty-gritty it's ineffectual and inefficient and doesn't have a soul.....
So you didn't answer the question. Does the person have the right to neglect do to cost and inconvenience, or do you empower the government to protect the life?
If you are the proxy you can make any choice that the person has written down and others as well.....that person has MADE you proxy.....if you have no proxy---the government will choose for you......
Isn't that the same thing that happens to unwanted babies? The government gets them, right? So we abort the unborn because of the cost and inconvenience, and we will soon be neglecting care to the elderly because of the cost and inconvenience.
saving life for the sake of saving life does not equate to living life
a person is a proxy to a pregnancy and carrys that responsibility regardless of the choice they make a parent is a proxy to a child and carrys that responsibility regardless of the choice they make a healthcare proxy is given that responsibility by another person and has choices to make
dont add the government into the equations....the law can only be what it sees as fact....the conscience of man CANNOT be weighed by man's laws, man's laws have no soul....a person always has the ability to make a 'good' choice or a 'bad' choice because we can....man's law is for AFTER the transgression and even then it's ambiguous at best... if abortion is illegal what would should be done to the person who has one when it is illegal? because that is the choice you are asking the government to rule on....is it the body the 'baby' is in that goes to jail or gets the electric chair? you see this is where the government loves to divide and conquer...
...you are a product of your environment, your environment is a product of your priorities, your priorities are a product of you......
The replacement of morality and conscience with law produces a deadly paradox.
STOP BEING GOOD DEMOCRATS---STOP BEING GOOD REPUBLICANS--START BEING GOOD AMERICANS
So if I'm caring for an elderly parent and acting health proxy, and the stress and inconvenience on my life, as well as the expense becomes too much to handle, can I neglect the medical care and cost necessary to sustain life? Or, as a society, do we allow the government to step in and save the life that is willfully being neglected?
After all, an aging parent is similar in an unwanted pregnancy in that i isn't your choice to have one. So is it fair to the children, since they have NO CHOICE but to be burdened withe an aging parent? How do you fix that problem?
there isn't a fix....it's just that individual......conversations like that belong in the family/church/doctors office etc.....dont let the government be your dialogue opener....the nitty-gritty of the conversation must be dealt with and it's each persons responsibility as to the road they pave... just like the libs sending my $$ to whom they find have insufficient ways of living(according to them) and then no one has responsibility why? because 'THEY' will take care of it.....it's not up to the commune government to insidiously remove our ability to act and we are that messy no matter how civilised we pretend to be....the unseen mysteries of the human will never be fully discovered in our time....there are theories but nothing to base our existence on.....
...you are a product of your environment, your environment is a product of your priorities, your priorities are a product of you......
The replacement of morality and conscience with law produces a deadly paradox.
STOP BEING GOOD DEMOCRATS---STOP BEING GOOD REPUBLICANS--START BEING GOOD AMERICANS
So you didn't answer the question. Does the person have the right to neglect do to cost and inconvenience, or do you empower the government to protect the life?
so what if the government protects the life....the government cannot make someone live.....
life does not equate to living
...you are a product of your environment, your environment is a product of your priorities, your priorities are a product of you......
The replacement of morality and conscience with law produces a deadly paradox.
STOP BEING GOOD DEMOCRATS---STOP BEING GOOD REPUBLICANS--START BEING GOOD AMERICANS
Starring: Ewan McGregor, Scarlett Johansson Director: Michael Bay
U.S. Opening Date: July 22, 2005
THEY SAY
Lincoln Six-Echo (McGregor) is a resident of a seemingly utopian but contained facility in the mid-21st century. Like all of the inhabitants of this carefully controlled environment, Lincoln hopes to be chosen to go to the “The Island” — reportedly the last uncontaminated spot on the planet. But Lincoln soon discovers that everything about his existence is a lie. He and all of the other inhabitants of the facility are actually human clones whose only purpose is to provide “spare parts” for their original human counterparts. Realizing it is only a matter of time before he is “harvested,” Lincoln makes a daring escape with a beautiful fellow resident named Jordan Two-Delta (Johansson). Relentlessly pursued by the forces of the sinister institute that once housed them, Lincoln and Jordan engage in a race for their lives to literally meet their makers.
...you are a product of your environment, your environment is a product of your priorities, your priorities are a product of you......
The replacement of morality and conscience with law produces a deadly paradox.
STOP BEING GOOD DEMOCRATS---STOP BEING GOOD REPUBLICANS--START BEING GOOD AMERICANS
so what if the government protects the life....the government cannot make someone live.....
life does not equate to living
Anarchy...Why have any laws protecting any life since the decision to kill or not kill isn't deterred by laws? We have degrees of murder, 1st 2nd and 3rd degree murder, yet we still have murder. Point taken...We should let it all fly. Lawlessness for all. Survival of the fittest. The strong will rule over the weak. No enforcement of the social contract. To each his own. If my neighbors child has an infection that is curable with an antibiotic, and they refuse to treat - so be it. If the child dies due to the neglect - IT"S THEIR CHOICE! If there is an elderly person living next door being neglected by his/her caretakers, so be it, their choice - it's none of my or the governments business.
I am a limited government person myself, but I believe one of the duties of our government in a civilized society is to protect the lives of those that are vulnerable from those that are stronger. Those people on both ends of the spectrum - from the unborn to the elderly better hope they have caring families, because in Senders world, your life lies in the hands of your guardian, and they are not bound by any laws of our society, your life is at their disposal. Good Luck - Don't get old or sick or gestated.
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