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I work at the Maryland State Department of Corrections. We have been discussing the need to do Advanced Directives with some of our incarcerated individuals who have serious health issues that will lead to incapacitation.Ìý Our medical contractor does a MOLST with most of our folks. Is that comparable to an Advanced Directive?
Since you are thinking about future care of these individuals should they become incapacitated, the advanced directive should be completed if they are competent to complete it. It designates a healthcare proxy who can make decisions for them, as well as outlines their healthcare wishes for the future. In contrast, the MOLST is a form for now, not the future, about life-sustaining treatments (i.e., CPR) for persons with current, serious life-threatening illness and transfers with the person to various healthcare settings. If the person is DNR, either the MOLST or EMS/DNR order approved by the Maryland Institute for Emergency Medical Services Systems must be completed.
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So, for your population, I think the answer is depends on the individual. If the current condition is life-limiting, like a terminal cancer diagnosis, then the MOLST is all that is needed. However, if the person has a dementia diagnosis, which is NOT a life-limiting condition, but will likely lead to the person becoming incapacitated as the disease progresses, the advanced directive should be completed. People without a medical diagnosis should also complete the advanced directive if they want control over healthcare decisions should something happen in the future. For these people, the forms should be reviewed periodically in case their wishes change over time.
