Medical Orders for Life-Sustaining Treatment (MOLST) is a standardized, actionable medical document used for end-of-life care planning. This form translates a person’s preferences and goals for care into specific, legally binding medical orders that healthcare providers must follow. MOLST is intended to ensure that a patient’s wishes are honored, especially for those with serious advanced illness or those nearing the end of life.
The Meaning and Requirement of the MOLST Form
MOLST carries the weight of a medical order, similar to a prescription, making it fundamentally different from a typical instruction. This order is created after a conversation between the patient (or their surrogate decision-maker) and a licensed clinician, such as a physician, nurse practitioner, or physician assistant. The form is often printed on a distinct color paper, such as bright pink, to maximize its visibility and immediate recognition in an emergency setting.
Because it is a medical order, healthcare providers across various settings are required to adhere to the documented decisions. The signed form serves as an official directive, ensuring a patient’s choices regarding life-sustaining treatments are clearly communicated and legally implemented. The clinician’s signature confirms that the document accurately reflects the patient’s informed consent and goals of care.
If a section of the MOLST form is left blank or a decision is deferred, providers often default to providing full treatment for that intervention. The form is designed to be comprehensive; any change in the patient’s condition or preferences necessitates a review and potential completion of a new, updated form. This requirement for a clinician’s signature and the immediate effect of the orders distinguish MOLST from general statements of preference.
Defining Life-Sustaining Treatment Orders
The MOLST form allows for explicit instructions across a range of life-sustaining medical interventions. One of the most common decisions documented is the patient’s Cardiopulmonary Resuscitation (CPR) status. The form specifies whether a patient wants full resuscitation (Full Code) or a Do Not Resuscitate (DNR) order, which means allowing natural death. The DNR order must be on the MOLST form to be honored by emergency medical services (EMS) personnel outside a hospital.
Beyond resuscitation, the form details choices regarding artificial ventilation, including mechanical support for breathing and intubation. A patient can specify whether they refuse intubation entirely or accept it with time limitations. Decisions about artificial nutrition and hydration are also recorded, covering the use of feeding tubes or intravenous fluids.
The MOLST form further addresses preferences for other treatments, such as the use of antibiotics, specifying if they should be used fully, limited, or withheld entirely. Patients can also articulate their preferences regarding future hospitalization, dialysis, and blood transfusions. These detailed specifications ensure the patient’s wishes are clear across all potential medical scenarios, translating personal values into definitive medical action.
MOLST Compared to Advance Directives
MOLST is frequently confused with traditional advance directives like a Health Care Proxy or a Living Will, but they serve distinct functions in end-of-life planning. A Health Care Proxy designates a specific person, called an agent, to make medical decisions on the patient’s behalf if they lose capacity. A Living Will is a general statement of a patient’s preferences regarding life-sustaining treatments if they become terminally ill or permanently unconscious.
The fundamental difference is that MOLST is an immediate, binding medical order, while advance directives are legal documents guiding future treatment. Advance directives are for any adult and only become effective after the patient loses decision-making capacity. In contrast, MOLST is typically recommended for patients with a serious, advanced chronic illness or frailty, and it is effective immediately upon being signed by the clinician and the patient.
An advance directive provides guidance, but a MOLST form is required to translate those general preferences into specific, actionable medical orders. For instance, while a Living Will may state a desire to refuse CPR, the MOLST form contains the actual “Do Not Resuscitate” order that must be followed by all providers, including emergency personnel. Having both documents is recommended: MOLST implements the orders, while the Proxy can speak for the patient if the orders are unclear or a new situation arises.
When and Where MOLST is Active
A defining characteristic of the MOLST form is its portability across different healthcare environments. The orders are valid in a wide range of settings, including hospitals, nursing homes, long-term care facilities, and the patient’s private residence. This portability ensures a seamless transition of care and consistent adherence to the patient’s wishes as they move between care sites.
Emergency medical services (EMS) personnel are trained to look for and honor the MOLST form, especially the DNR and Do Not Intubate (DNI) orders, in emergency situations. The form must remain with the patient at all times, and a copy or the original must be transferred with them upon discharge or transfer. The receiving clinician at a new facility is expected to review the form and may revise it if the patient’s condition or preferences have changed.
The implementation and legal authority of MOLST are governed by state laws. The form’s name and exact requirements can vary regionally; for example, some states use the acronym POLST (Physician Orders for Life-Sustaining Treatment). Regardless of the acronym, the core function remains a standardized, clinician-signed order that ensures patient preferences for life-sustaining treatment are respected throughout the healthcare continuum.