Medical Orders for Life-Sustaining Treatment (MOLST) is a standardized medical form used in several states to document a patient’s choices concerning end-of-life care. The MOLST form translates a person’s preferences and goals into a set of actionable medical orders. These orders must be followed by all healthcare providers, ensuring a patient’s wishes regarding specific life-sustaining treatments are respected, particularly in emergencies. The process centers on a conversation between the patient (or their surrogate) and a licensed healthcare professional to ensure informed decision-making.
Defining MOLST and Its Purpose as a Medical Order
MOLST functions as a portable, physician-signed medical order that directs healthcare personnel on which specific interventions to provide or withhold. This form is intended for patients with a serious illness, advanced frailty, or those facing a significant likelihood of death within the next year. It is designed for individuals whose current health condition makes end-of-life decisions immediately relevant, not for the general adult population.
The form is often printed on brightly colored paper (such as pink or green) to ensure it is immediately visible and recognizable by all medical staff, including emergency medical service (EMS) personnel. This distinct visual format helps prevent delays in critical care settings, where quick identification of a patient’s wishes is important. The orders are based on thorough discussions about the patient’s prognosis, values, and goals of care.
The document systematically addresses critical medical decisions that may arise during a serious health crisis. Sections include specific instructions regarding cardiopulmonary resuscitation (CPR), allowing the patient to choose either “Attempt Resuscitation” or “Do Not Resuscitate” (DNR). It also covers the use of mechanical ventilation and intubation, specifying if these measures should be withheld or withdrawn.
The MOLST form also documents choices about other life-sustaining treatments. Patients specify preferences concerning artificial nutrition and hydration, such as feeding tubes or intravenous fluids. Instructions regarding the use of antibiotics and goals for future hospitalization or transfer to a different care setting are also outlined, creating a comprehensive treatment plan that is legally binding for all medical providers.
How MOLST Differs from Advance Directives
The fundamental difference between MOLST and traditional advance directives (like a Living Will or Health Care Proxy) is that MOLST is an immediate medical order. It is signed by a licensed healthcare provider, giving it the same authority as any other physician-written order in a patient’s medical chart. A Living Will, conversely, is a legal document expressing general preferences but is not an actionable medical order and often requires interpretation.
Advance directives are appropriate for any adult and are primarily used to appoint a healthcare agent or provide general guidance for future care if the patient loses decision-making ability. They are typically activated only when a patient is incapacitated. MOLST, designed for patients with serious illness, is effective immediately upon signing, regardless of the patient’s current capacity.
Because MOLST is a medical order, it must be followed by emergency medical services (EMS) personnel in the field. EMS providers are generally unable to honor instructions in a Living Will or Health Care Proxy because those documents are not standardized medical orders. The clear, specific instructions on the MOLST form eliminate the need for interpretation during an emergency, ensuring rapid compliance with the patient’s treatment wishes.
The specific nature of the MOLST form provides clear direction, such as “Do Not Intubate” or “Limited Medical Interventions,” which is more precise than the general statements often found in a Living Will. While both tools are part of advance care planning, MOLST translates the broader principles of an advance directive into legally enforceable, portable medical commands. The two documents are complementary, but MOLST holds greater weight in an acute medical crisis.
The Implementation and Portability of MOLST
For the MOLST form to be valid, it must result from a thorough conversation between the patient (or their legally authorized representative) and a qualified healthcare professional. This discussion ensures the patient understands their diagnosis, prognosis, and the risks and benefits of the treatments being considered. The final form requires the signature of a licensed healthcare provider, typically a physician, nurse practitioner, or physician assistant, depending on state laws.
Once completed and signed, the original MOLST form must remain accessible, often kept in a prominent location in the patient’s home and entered into their electronic medical record. This constant accessibility is necessary for all providers, especially those who may not know the patient personally. The portability of the document is a defining feature, allowing the orders to travel across all care transitions.
The orders remain valid as the patient moves between different healthcare settings, such as a private home, assisted living facility, hospital, or nursing home. Emergency medical personnel are trained to honor a valid MOLST form during a crisis, ensuring continuity of care. However, MOLST is governed by state law, meaning its specific format and validity can vary, and an out-of-state form may require review and conversion by a local provider.
MOLST orders can be reviewed and revised at any time if the patient’s medical condition changes or if they change their mind. A new form replaces the old one, and healthcare providers must follow the most recently signed document. This ability to update the orders ensures the medical plan remains consistent with the patient’s current health status and preferences.