The acronym MOLST stands for Medical Orders for Life-Sustaining Treatment, a specific type of advance care planning document. This form translates an individual’s end-of-life preferences into immediate, actionable medical orders. Its primary purpose is to ensure a patient’s wishes are consistently honored across various healthcare settings, including hospitals, nursing homes, and the community. MOLST is generally intended for patients with serious illness or advanced frailty, where death within the next year is not unexpected.
Translating Wishes into Actionable Medical Orders
The MOLST form functions as a set of doctor’s orders, similar to a prescription, that healthcare professionals must follow immediately. This is a significant distinction from general statements of intent, as it carries the full authority of a medical directive. The form must be signed by a licensed physician, nurse practitioner, or physician assistant, confirming that the orders are based on a shared, informed decision-making process between the patient and the clinician.
The document details specific choices for multiple categories of life-sustaining treatments. These choices include whether to attempt Cardiopulmonary Resuscitation (CPR) if the patient’s heart or breathing stops. It also addresses instructions for mechanical ventilation, which involves a machine breathing for the patient, and whether to use a Do Not Intubate (DNI) order.
Beyond resuscitation and ventilation, the MOLST form guides decisions on the use of artificial nutrition and hydration, such as feeding tubes and intravenous fluids. It also covers preferences for the use of antibiotics, blood transfusions, dialysis, and the overall level of treatment desired, ranging from full treatment to comfort measures only. Since the form is a medical order, it is transferable, ensuring continuity of care that aligns with the patient’s goals regardless of where they receive treatment.
How MOLST Differs from Health Care Proxies and Living Wills
MOLST, a Health Care Proxy, and a Living Will are all tools for advance care planning, but they serve different roles. A Health Care Proxy designates a specific person (an agent or surrogate) to make medical decisions on the patient’s behalf if they lose capacity. This document focuses on who makes the decision when the patient cannot.
A Living Will is a legal document that outlines a patient’s general wishes regarding life-sustaining treatments, typically when facing a terminal condition or persistent vegetative state. While it provides guidance, it often requires interpretation by the healthcare agent or medical team and is not a direct medical order.
The MOLST form is a physician-signed medical order that is immediately executable and does not require a determination that the patient has lost decision-making capacity. It is more specific and actionable than the general instructions found in a Living Will, and must be followed by all healthcare providers, including Emergency Medical Services (EMS) personnel. The MOLST complements these other documents by translating the general intent of a Living Will into concrete medical instructions.
The Practical Steps of Completing the Form
Establishing a valid MOLST form begins with a mandatory, in-depth conversation between the patient (or their designated decision-maker) and a qualified healthcare professional. This discussion is essential for defining the patient’s goals for care, reviewing their prognosis, and ensuring the patient understands the potential benefits and burdens of each treatment option. The conversation must result in shared, informed medical decision-making documented in the patient’s medical record.
For the form to be legally valid, it requires the signature of the patient or their authorized surrogate and a licensed physician, nurse practitioner, or physician assistant. In many states, the form is printed on a distinct, bright pink paper to ensure it is immediately noticeable in an emergency situation. The physical form must be kept with the patient, often in an easily accessible location like on the refrigerator door, and must travel with them between different care settings.
The MOLST is not a permanent document, and it must be reviewed periodically, especially if the patient experiences a major change in health status, moves to a new care setting, or changes their mind about treatment. If preferences change, the current form is voided, and a new one is completed to reflect the updated medical orders. This review process ensures the medical orders remain consistent with the patient’s current condition and values.
Variations in Terminology and State Validity
MOLST is a regional name for a program that is part of a larger national movement called the Physician Orders for Life-Sustaining Treatment (POLST) Paradigm. Because each state develops its own specific program, the name and implementation details vary widely. States may use names like POLST, POST (Physician Orders for Scope of Treatment), or COLST (Clinician Orders for Life-Sustaining Treatment).
Different program names and forms highlight that the document’s portability and legal status can be inconsistent when crossing state lines. While the underlying goal is the same—to provide portable medical orders—a form valid in one state may not be immediately recognized or honored as a medical order in another. The National POLST Paradigm Task Force works toward standardization, but legal and logistical barriers mean that a truly national, uniform form does not yet exist.