MOLST: Medical Orders for Life-Sustaining Treatment
What is MOLST?
Medical Orders for Life-Sustaining Treatment (MOLST) is a program designed to improve the quality of care patients receive at the end of life by translating patient goals for care and preferences into medical orders. MOLST is based on communication between the patient, his or her health care agent or other designated surrogate decision-maker, and healthcare professionals that ensures shared, informed medical decision-making.
The MOLST program was created to complement the use of traditional advance directives and facilitate the communication of medical orders impacting end-of-life care for patients with advanced chronic or serious illness.
The MOLST form contains specific doctor's orders that go with the patient to all healthcare settings, including the patient's home. Healthcare proxies and living wills typically contain more general instruction, and cannot be followed by EMS providers in an emergency.
The MOLST program is based on the belief that patients have the right to make their own healthcare decisions, including decisions about life-sustaining treatment, to describe these wishes to healthcare providers, and to receive comfort care while wisher are being honored.
What is the MOLST form?
The New York State Department of Health approved a physician order form that can be used throughout the state by doctors, hospitals, nursing homes, and other healthcare providers.
The MOLST form is a bright pink medical order form signed by a New York State physician that tells others the patient's medical orders for life-sustaining treatment. All healthcare professionals must follow these medical orders as the patient moves from one location to another, unless a physician examines a patient, reviews the orders, and changes them.
The advantage of the MOLST form is that it is transferable to other settings across the healthcare spectrum. For example, DNR (Do Not Resuscitate order) issued on a MOLST form is effective in hospitals, nursing homes and community settings.
The MOLST serves as a single document that contains a patient's goals and preferences regarding:
- Resuscitation instructions when the patient has no pulse and/or is not breathing
- Instructions for intubation and mechanical ventilation when the patient has a pulse and the patient is breathing
- Treatment guidelines
- Future hospitalization and transfer
- Artificially administered fluids and nutrition
Who can doctors use the MOLST form for?
Adults, minors, persons with developmental disabilities, and those with mental illness.
What type of person should have a MOLST form?
MOLST is generally for patients with serious health conditions and may be appropriate for use with patients of advanced age. Patients with serious health conditions typically include those who have advanced, chronic, progressive illness and/or frailty (significant weakness and extreme difficulty with personal care activities) and those who might die or lose the ability to make medical decisions within the next year.
How is the MOLST form completed?
The MOLST form must be completed based on the patient's current medical condition, values, wishes, and informed consent.
Completion of the MOLST form begins with a conversation or a series of conversations between the patient, the healthcare agent or the surrogate, and a doctor that defines the patient's goals for care, reviews possible treatment options on the MOLST form.
How is the patient or surrogate involved in this process?
The patient or surrogate (a healthcare agent or Public Health Law surrogate, if the patient does not have the ability to make medical decisions about life-sustaining treatment) must consent to the MOLST orders. If the patient does not have a surrogate and can't consent to the MOLST orders, there is a provision for enacting the MOLST orders with the patient's best interests in mind.