FAQ: Medical Orders for Life-Sustaining Treatment (MOLST)

ThinkstockPhotos-514443191MOLST stands for Medical Orders for Life Sustaining Treatment.  In some states, they call these orders POLST for Physician’s Orders for Life Sustaining Treatment. Generally speaking, MOLST is a document which gives medical orders about life-sustaining treatment for patients with an advanced illness. MOLST is not intended for use by healthy people.

MOLST is new in Massachusetts. The government authorized MOLST in 2008 and the Executive Office of Health and Human Services has been testing it since then. In 2012 the EOHHS began expanding the use of MOLST and in 2014 the document began to be used statewide.

The Massachusetts Health Care Proxy—Is It Still Relevant? 

MOLST does not take the place of the Health Care Proxy.  The Health Care Proxy is a legal document in which the principal appoints an agent to make health care decisions for him or her. The agent only has authority to make medical decisions when a doctor certifies that the principal can not make or communicate his/her own medical decisions.   The Health Care Proxy continues to be the only legal document which is binding on medical professionals.   The Health Care Proxy is signed by the principal and two neutral witnesses. All adults, whether sick or healthy, should have a Health Care Proxy.  Click here to access the form at the Massachusetts Medical Society.

How MOLST is Different?

MOLST is a medical document intended only for adults with a current advanced illness. It is signed by the patient and his or her physician after a detailed conversation.  It goes into effect immediately upon signing.  MOLST provides medical orders which can be honored by clinicians across all health care settings.

When you look at the MOLST form and compare it to the Health Care Proxy form, you will see that the Health Care Proxy does not have any language concerning end-of-life treatment.  It simply appoints the Health Care Agent.  In contrast, MOLST has details concerning end-of-life treatment and emergency treatment which are specific to the patient’s illness.  The wishes you express in your MOLST can be honored by EMTs and by emergency room personnel.

Are You Signing a Death Warrant?  Are You Signing Away Your Right to Make Your Own Decisions?

No!  You can always change your mind about your treatment.   The medical community understands that a patient’s condition can change and a patient’s wishes and goals may change.   

By law, no one can be required or forced to execute a MOLST.  However, we have noticed that some nursing homes are requiring MOLST as a condition to enter the nursing home.  This is not appropriate! Nursing homes/rehabilitation centers have long required patients to have a Health Care Proxy form, but they should not expect otherwise healthy individuals to sign a MOLST.  If you run into such a situation, you may need your doctor to call or write the nursing home to advise them that a MOLST is not appropriate for your situation. 

Execution of MOLST

A MOLST form can be signed by a patient after a conversation with a doctor or other clinician, but it can also be signed by a Health Care Agent on behalf of a patient if the patient is incapacitated and the Health Care Proxy has been invoked.

Where Do You Get the Form and More Information?

You can get the form from your doctor or clinician.  You can get more information by clicking on the MOLST website.

Margaret Hoag is an attorney with Eckel, Morgan & O’Connor, LLC in Acton, Massachusetts.  She concentrates her practice in the area of elder law, including long-term care planning, guardianship and conservatorship, MassHealth (Medicaid) application, estate planning, and probate administration.