Medical Orders for Life Sustaining Treatment - Patients & Families

Development of the MOLST Program

The Community-wide End-of-life/Palliative Care Initiative, a Rochester, New York-based initiative aimed at improving end of life care in New York, created the Medical Orders for Life-Sustaining Treatment (MOLST) Program.

Medical Orders for Life-Sustaining Treatment (MOLST) was adapted from an Oregon program called Physician Orders for Life-Sustaining Treatment (POLST). POLST developed in the early 1990’s, communicates medical orders describing an individual’s preferences for life-sustaining treatments. POLST was designed for use in all care settings including the hospitals, long-term care facilities and the community.

Examples of life-sustaining treatments:

• Cardiopulmonary resuscitation (CPR or “code status”)
• Intubation and mechanical ventilation
• Antibiotics
• Artificial hydration and nutrition (feeding tube)

According to research performed in Oregon over the past decade, Advance Care Planning is more effective after POLST is instituted. End-of-life care preferences are more accurately conveyed and more likely followed by medical professionals. Unwanted hospitalizations at the end of life are reduced as well.

Eager to replicate Oregon’s success, other states are now instituting this model. MOLST was developed because POLST is inconsistent with New York State’s laws and regulations.

A Special Thanks... Special thanks to the primary care physicians, emergency room doctors, EMS staff, nurses, pulmonologists, intensivists, palliative care specialists, social workers, lawyers, consumers, long-term care facility staff, hospice workers and home care staff that created MOLST. Click here for a complete list of members of the MOLST Creation Workgroup. Special thanks to New York State Department of Health (NYSDOH) and the Medical Society of the State of New York (MSSNY) Ethics Committee for their support of the MOLST Pilot legislation and Chapter Amendment, as well as countless community collaborators and professional associations across the state for their support of implementation of the MOLST Program. Special thanks to Excellus BlueCross BlueShield for moving MOLST beyond the Rochester community.