New End of Life Law

Medical/Physician’s Orders for Scope of Treatment

Kentucky and Indiana (Ohio Pending)

Did you know that in the last month of life over 50% of Americans go to the emergency room and that 50% to 75% of them get admitted? However, some people might not want to spend the last month of their lives in a hospital. Hospitalization is expensive and usually not considered an ideal place to die. You can avoid these unwanted end of life experiences through proper advance care planning.

The newest tool for advance care planning is medical or physician’s orders for scope of treatment. Nationally this new tool is being referred to as a POLST, which stands for Physician’s Orders for Life-Sustaining Treatment.  The National POLST Paradigm is an organization started in Oregon that helps push for the adoption of medical order documents across the country. Over 22 states have endorsed the POLST program, and 25 others are developing similar programs. Kentucky and Indiana are two such states. In Kentucky, these documents are known as MOST or Medical Orders for Scope of Treatment. In Indiana, they are known as POST or Physician Orders for Scope of Treatment. However, Ohio has not been successful in passing a POLST initiative. Ohio’s MOLST (Medical Orders for Life-Sustaining Treatment) bill has passed the Ohio Senate and has been referred to committee in the House. These documents go by a few different names depending on the state, but generally, they do the same thing.

POLST type documents are meant to encourage patients and their health care professionals to talk about what a patient wants at the end of life. The MOST document, unlike a living will, is a doctor’s orders. The fact that they are orders instead of a legal document leads to increased compliance by emergency medical personnel and hospital staff. Unlike a living will, MOST documents are filled out jointly by the patient and their physician. The purpose of this joint involvement is informed, shared decision-making between patients and healthcare professionals. The conversation involves the patient discussing his/her values, beliefs and goals for care, and the healthcare professional presents the patient’s diagnosis, prognosis, and treatment alternatives, including the benefits and burdens of life-sustaining treatment. Together they reach an informed decision about desired treatment, based on the patient’s values, beliefs, and goals for care.

However, MOST documents are not recommended for everyone. They are highly recommended for patients for whom their health care professionals would not be surprised if they were no longer living within a year. Patients should, however, have in place a living will and possibly a MOST document. The MOST document allows for a patient to dictate how they will spend their final days. The MOST document makes sure that everyone in the healthcare field knows exactly what the patient’s wishes are and that they follow those wishes.

Conversations about end of life planning are difficult. However, if you don’t have them it can be even more difficult for your family to figure out your wishes. Have these conversations with your family members and consider putting in place a living will and if necessary a medical order for treatment document. If you need help putting these documents into place or have any questions feel free to reach out to our office.


Bill Hesch is a CPA, PFS (Personal Financial Specialist), and attorney licensed in Ohio and Kentucky who helps clients with their financial and estate planning. He also practices elder law, corporate law, Medicaid planning, tax law, and probate in the Greater Cincinnati and Northern Kentucky areas. His practice area includes Hamilton County, Butler County, Warren County, and Clermont County in Ohio, and Campbell County, Kenton County, and Boone County in Kentucky.

(Legal Disclaimer: Bill Hesch submits this blog to provide general information about the firm and its services. Information in this blog is not intended as legal advice, and any person receiving information on this page should not act on it without consulting professional legal counsel. While at times Bill Hesch may render an opinion, Bill Hesch does not offer legal advice through this blog. Bill Hesch does not enter into an attorney-client relationship with any online reader via online contact.)

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