A MOLST is a Medical Orders for Life-Sustaining Treatment, a standardized medical form that translates a patient’s end-of-life care wishes into actionable doctor’s orders. Unlike a living will or health care proxy, which express general preferences, a MOLST contains real medical orders that paramedics, nurses, and doctors must follow across every care setting, from hospitals to nursing homes to a patient’s own home.
The form is designed for people with serious health conditions, particularly those who might die within the next year, who reside in long-term care, or who have strong preferences about which life-sustaining treatments they do or don’t want. Several states use the MOLST name, including New York, Massachusetts, Maryland, Connecticut, Ohio, Rhode Island, and Alaska. Other states have nearly identical programs under different names, most commonly POLST (Physician Orders for Life-Sustaining Treatment).
What a MOLST Form Covers
A MOLST addresses the specific medical interventions most likely to come up during a health crisis. The core categories include:
- CPR: Whether to attempt chest compressions, electric shock, and a breathing tube if the heart stops.
- Intubation and mechanical ventilation: Whether to place a tube down the throat and connect it to a machine that pumps air into the lungs if the person can’t breathe on their own.
- Artificial nutrition and hydration: Whether to provide liquid food through a tube inserted into the stomach, or fluids through an IV, if the person can no longer eat or drink. If a patient declines both options, caregivers offer food and fluids by hand as tolerated.
- Future hospitalization: Whether the patient wants to be transferred to a hospital or prefers to stay in their current setting.
- Antibiotics: Whether to use antibiotics to treat infections, and if so, how aggressively.
For each category, the form presents a range of options rather than a simple yes or no. A person might choose full treatment in one area and comfort-focused care in another. The result is a personalized set of orders that reflects exactly what that individual wants.
How MOLST Differs From an Advance Directive
People often confuse a MOLST with a living will or health care proxy, but they serve different purposes and carry different legal weight. A living will follows an “if, then” model: “If I lose the ability to make decisions and I’m in a terminal condition, then don’t use a ventilator.” It’s a set of preferences about hypothetical future situations. A health care proxy names someone to make medical decisions on your behalf, but only kicks in after you’ve lost the capacity to decide for yourself.
A MOLST, by contrast, takes effect immediately. The moment a patient consents and a physician, nurse practitioner, or physician assistant signs the form, those orders are active. There’s no waiting for a capacity determination. The orders are specific, not general, and they’re binding on medical professionals in a way that advance directives often aren’t.
This distinction matters most in emergencies. EMS providers are trained to follow MOLST orders but generally cannot act on the instructions in a living will. In New York, for example, the MOLST is the only authorized form for documenting a do-not-resuscitate or do-not-intubate order outside of a hospital. Without one, paramedics arriving at your home will attempt full resuscitation regardless of what your living will says.
A MOLST doesn’t replace advance directives. Ideally, it works alongside them. Your advance directive names your decision-maker and outlines your values, while the MOLST converts those values into concrete medical orders a first responder can act on in minutes.
Who Should Have a MOLST
A MOLST isn’t for everyone. It’s intended for people with serious, progressive illnesses or conditions where death within the next year is a realistic possibility. That includes people with advanced cancer, severe heart failure, late-stage dementia, or other conditions where a sudden decline could happen at any time. Residents of nursing homes and people receiving long-term care services are also within the intended population.
Healthy adults don’t need a MOLST. A health care proxy and living will are the appropriate planning tools for someone without a current serious illness. The MOLST becomes relevant when a person’s health has declined to the point where decisions about CPR, ventilators, and feeding tubes are no longer hypothetical but likely to come up soon.
How the Form Gets Created
A MOLST begins with a conversation between the patient (or their authorized decision-maker) and a qualified clinician. The clinician walks through each treatment category, explains what each intervention involves and how likely it is to help given the patient’s condition, and documents the patient’s choices as medical orders on the standardized form.
The form must be signed by a physician, nurse practitioner, or physician assistant to become active. The clinician signing it certifies that the orders resulted from a genuine discussion and informed consent, whether that consent came from the patient directly, a health care agent named in an advance directive, a legal guardian, or an authorized surrogate. The completed form then travels with the patient, remaining valid in hospitals, hospice facilities, nursing homes, and the community.
Portability and Emergency Use
One of the most important features of a MOLST is that it’s portable. The same form applies whether you’re at home, in an ambulance, in a nursing facility, or admitted to a hospital. EMS clinicians are required to honor the orders on a MOLST form in all settings. If a patient has two MOLST forms with different dates, responders follow the most recent one.
States also recognize each other’s forms. An out-of-state POLST is treated as equivalent to a MOLST by emergency responders. This means the protections travel across state lines, which matters for patients who split time between states or are transferred between facilities in different regions.
There’s one important override: if a patient is conscious and tells paramedics they want to be resuscitated, their spoken wishes take priority over the form. The MOLST is a standing order, not an irreversible contract. A living person who can communicate always has the final say. If the patient can’t communicate and a confirmed health care agent is present, EMS may follow that agent’s instructions. In conflicting or unclear situations, responders contact a physician for real-time guidance.
Changing or Revoking a MOLST
A MOLST can be updated or revoked at any time. Preferences often shift as a person’s condition changes, new treatments become available, or priorities evolve. Any revision requires a new conversation with a clinician and a new signature. The updated form supersedes all previous versions.
Because health conditions and patient goals change, reviewing the MOLST periodically is important. A natural time to revisit it is during any significant change in health status, a new diagnosis, a hospital admission, or a transfer between care settings. The form should always reflect what the patient wants right now, not what they wanted six months or two years ago.