Massachusetts Medical Orders For Life Sustaining Treatment (MOLST)

A MOLST is a clinical form and standard of care which describes your wishes for certain medically appropriate life-sustaining treatments in a medical emergency.   It is a medical professional’s order that helps you keep control over medical care at the end of life.  Similar to a Comfort Care/Do Not Resuscitate (DNR) Order, the MOLST forms informs emergency medical personnel and other health care providers whether or not to administer cardiopulmonary resuscitation (CPR) in the event of a medical emergency. 

The MOLST forms differs from a DNR order in one important way.  A DNR directs ambulances and EMTs to not provide resuscitation serves (CPR, ventilation, chest compressions, defibrillations, etc.) to you.  Without this form, they must resuscitate, even if a health care agent is telling them not to or your living will says different.  A DNR in a hospital setting directs the hospital staff to refrain from resuscitating you. 

The MOLST form includes directions about life-sustaining measures in addition to CPR/ventilation, such as intubation, dialysis, antibiotic use, artificial hydration and feeding tubes.  You can request to either receive or refuse the treatment options. For each treatment you can choose no treatment, use the treatment, use it for short term/trial basis, or undecided. In addition, the MOLST form can be honored by all health professionals across care settings, not just EMTs.    If you have both a DNR form and a MOLST form, the most recent orders will be followed for cardiac/respiratory arrest.  In other situations, the MOLST orders apply. 

The MOLST form helps medical providers understand your wishes at a glance but it is NOT a substitute for a properly prepared living will and health care proxy.  A living will and health care proxy provide more information than a MOLST form and appoints a health care agent who is authorized to make health care decisions on your behalf if you should become incapacitated.

Completing a MOLST form is voluntary.  A physician, physician’s assistant or nurse practitioner can help you create a MOLST form when you enter a health care setting such as a hospital, nursing home or hospice care in a facility or at home.  You may also ask for a form. Prior to signing the MOLST form, you and your physician will discuss your health condition, prognosis, values and goals for care and the benefits and burdens of treatment.

A valid MOLST form must be signed by both the patient and the attending physician, physician’s assistant or nurse practitioner.   A health care agent may sign for the patient but only if the patient has lost capacity.  If a patient has not appointed a health care agent prior to  losing capacity to sign a MOLST form, no one is authorized to sign on his or her behalf unless a court-appointed guardian is granted the authority to do so.

The MOLST form is typically printed on bright pink paper so it will stand out in your medical records.  Page one of the MOLST form contains valid medical orders about CPR, intubation, ventilation and transfers to a hospital.  Page two of the form facilitates further expressions of a patient’s other preferences and indicates the extent of the discussions that have occurred.

The original MOLST forms stays with you.  You should keep it where it is easy to find, such as the refrigerator, the back of a door or at bedside as well as keep a copy in your wallet for travel outside of the home.  Copies of the form are valid. 

The form travels with you if you move from one health care setting to another. The MOLST form can be changed or cancelled at any time. You can also request and receive treatment at any time even if your MOLST forms says “do not use” that treatment. 

If you are diagnosed with a terminal illness, dementia, medical frailty or are facing a life-threatening medical condition and you feel strongly that you would not want emergency measures at the end of life, you should consider a MOLST form in addition to traditional health care directives. A living will and health care proxy may not be enough to prevent medical personnel from resuscitating you in an emergency.