Title 23
Health and Safety

Chapter 4.11
Rights of the Terminally Ill Act

R.I. Gen. Laws 23-4.11-3.1



 23-4.11-3.1.  Medical orders for life sustaining treatment.


(a) The department of health shall establish rules and regulations, consistent with the provisions of this section, for the establishment of Medical Orders for Life Sustaining Treatment and the structure and content of Medical Orders for Life Sustaining Treatment forms.

(b) (1) A declaration by a qualified patient may be recorded as a medical order for life-sustaining treatment provided that:

(i) The medical orders for life-sustaining treatment and medical intervention and procedures are explained by a MOLST qualified healthcare provider to the qualified patient or healthcare decision maker. The MOLST qualified healthcare provider shall further inform the patient of the difference between an advance healthcare directive and MOLST medical order;

(ii) A MOLST qualified healthcare provider has conducted an evaluation of the qualified patient; and

(iii) A MOLST form documenting the declaration has been completed by a MOLST qualified healthcare provider based on qualified patient preferences and medical appropriateness, and has been signed by a MOLST qualified healthcare provider and the qualified patient or his or her recognized healthcare decision maker.

(2) A healthcare decision maker may execute the MOLST form if the qualified patient lacks capacity, or if the qualified patient has designated that the healthcare decision maker's authority is valid.

(3) A request regarding resuscitative measures may also be evidenced by the words "do not resuscitate" or the letters "DNR," in a qualified patient's medical record and/or through a mechanism established by the department of health consistent with the provisions of chapter 23-4.11.

(c) (1) A healthcare provider shall treat a qualified patient in accordance with the qualified patient's MOLST, subject to the provisions of this chapter.

(2) A MOLST qualified healthcare provider may conduct an evaluation of the qualified patient and if necessary, in consultation with the qualified patient or recognized healthcare decision maker, issue a new MOLST consistent with the most current information available about the qualified patient's health status and care preferences.

(3) The recognized healthcare decision maker of a qualified patient who is without capacity shall consult with the MOLST qualified healthcare provider prior to making a request to modify the qualified patient's MOLST.

(d) (1) MOLST Form.  A MOLST shall be documented on an easily identifiable form approved by the director. The director shall promulgate rules and regulations for the implementation of this section.

(2) The MOLST form shall be signed by the qualified patient, or the qualified patient's recognized healthcare decision maker, and a MOLST qualified healthcare provider.

(3) The MOLST form shall contain all other information as required by this section.

(e) (1) A MOLST shall apply regardless of whether the qualified patient executes the MOLST form within or outside a hospital or other healthcare setting.

(2) The MOLST form is valid within or outside a hospital or other healthcare setting.

(f) (1) Revocation.  A qualified patient or his/her recognized healthcare decision maker may, at any time, revoke in any manner that communicates an intent to revoke his/her declaration by informing the MOLST qualified healthcare providers, other healthcare providers, or any member of the medical or nursing staff of the revocation of the declaration concerning life-sustaining or resuscitative measures.

(2) Any member of the medical or nursing staff informed of a revocation shall immediately notify a MOLST qualified healthcare provider of the revocation.

(3) The MOLST qualified healthcare provider informed of a revocation of MOLST made pursuant to this section shall immediately:

(i) Record the revocation in the qualified patient's medical record;

(ii) Cancel any orders implementing the decision to withhold or withdraw treatment; and

(iii) Notify the healthcare providers and staff directly responsible for the qualified patient's care of the revocation and any cancellations.

(4) If a decision to withhold or withdraw life-sustaining treatment has been made by a recognized healthcare decision maker pursuant to this section, and the MOLST qualified healthcare provider determines at any time that the decision is no longer appropriate or authorized because the qualified patient has regained decision-making capacity or because the qualified patient's condition has otherwise improved, the MOLST qualified healthcare provider shall immediately:

(i) Include such determination in the qualified patient's medical record;

(ii) Cancel any orders or plans of care implementing the decision to withhold or withdraw life-sustaining treatment;

(iii) Notify the healthcare decision maker who made the decision to withhold or withdraw treatment; and

(iv) Notify the other healthcare providers, including the medical and nursing staff directly responsible for the qualified patient's care, of any cancelled MOLST orders or plans of care.

(g) If a qualified patient with a MOLST order is transferred from a hospital, a licensed health facility, or the community, the MOLST order or plan shall remain effective until a MOLST qualified healthcare provider first examines the transferred qualified patient, whereupon a MOLST qualified healthcare provider shall issue appropriate orders to continue the prior order or plan. Such orders may be issued without obtaining another consent to withhold or withdraw life-sustaining treatment pursuant to this chapter.

(h) The MOLST is a voluntary option for qualified patients.  No patient is required to elect a MOLST.

History of Section.
P.L. 2012, ch. 187, 2; P.L. 2012, ch. 199, 2; P.L. 2013, ch. 501, 4.