1. Following the Patient’s Health Care Journey: Improving End of Life Care by Incorporating the MOLST into the Conversation Jeanne Ryan Executive DirectorVNA & Hospice of Cooley Dickinson “Something deep and sanctifying takes place when people who belong to each other share the thought that every day, each coming hour, may separate them. In this awareness we always find that the initial anxiety gives way to another deeper question: Have we given each other everything we could?” Dr. Albert Schweitzer

2. National Perspective

3. State Perspective

4. State Perspective October 2010, To The People of the Commonwealth: In our richly pluralistic nation and Commonwealth, we have many—and sometimes passionate—differences about important issues, including the most profound moral questions regarding life and death. Nonetheless, we have found that there is deep and widespread agreement in the Commonwealth about the following principles:

5. State Perspective 1. The life of every person is of incalculable value, through the very end of life. 2. Medical decisions require the informed consent of the patient (or appropriate surrogate), and must always be anchored in the patient’s own values and preferences. 3. While we all share in common the fact of our mortality, our individual values, priorities, and preferences regarding death and dying are highly variable.

6. State Perspective 4. Care for patients with serious, advancing illness must therefore always be individualized, with patients supported in making well-informed choices from among the full range of options for their care—whether aggressively life-prolonging, or entirely comfort-focused, or some balance of the two. 5. An ethical health care system—one committed to universal patient-centered excellence—would ensure that patients receive the care they want and need near the end of life.

7. State Perspective

8. Local Perspective

9. Local Perspective The Conversation Continues: Nuts and Bolts of End of Life Care. Introducing MOLST to the Community

10. Local Perspective • Video made to Train Physicians in MOLST Conversation • Conversation is a two-way street between Physician and their Patient/Families • Patients/Community members must be trained to participate in MOLST discussions if they are to receive the care they want • Video is being used to train community members to be active participants in MOLST conversations

11. Local Perspective • MOLST Video

12. Local Perspective • Questions??