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LIFE-SUSTAINING TREATMENT CONVERSATION GUIDE

Get ready for the conversation about life-sustaining treatment with your doctor, nurse practitioner, or physician assistant.

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🔒 Private, always: your notes are kept only on this device, automatically. Nothing here is ever sent anywhere.

Which State Are You In?

Every state calls this a little differently, and has its own program to contact.

Before You Begin

Topic 1 of 8

CPR (Resuscitation)

If your heart or breathing were to stop, would you want CPR attempted? Some people want every effort made; others prefer to be kept comfortable and allow a natural passing, with or without a breathing tube. There's no right answer — only what's right for you.

Topic 2 of 8

Breathing Machines (Ventilation)

If you needed help breathing, would you want a ventilator used indefinitely, only as a short trial to see if you improve, a simpler mask-based breathing support (like CPAP), or none at all?

Topic 3 of 8

Blood Transfusion

Would you want to receive blood or blood products if medically needed, or not?

Topic 4 of 8

Going to the Hospital

If something happens, would you want to be taken to a hospital for any situation, only for severe symptoms that can't be managed otherwise, or would you prefer to be treated and stay where you are?

Topic 5 of 8

Medical Testing

Would you want full diagnostic testing to find and treat problems, only limited testing aimed at comfort, or none at all?

Topic 6 of 8

Antibiotics

Would you want antibiotics used fully if medically needed, only in pill form, only for comfort, or not at all?

Topic 7 of 8

Artificial Nutrition and Fluids

If you couldn't eat or drink on your own, would you want a feeding tube or IV fluids used indefinitely, tried for a limited time, or not used at all?

Topic 8 of 8

Dialysis

If your kidneys were failing, would you want ongoing dialysis, a limited trial of it, or none?

Your Notes, All Together

Print these to bring to your appointment. Your doctor, NP, or PA will use the real MOLST form to turn your decisions into valid medical orders.