Medical Orders for Life Sustaining Treatment - Patients & Families

Frequently Asked Questions (FAQs)

Patients, families, and persons who make decisions on behalf of those who have lost the ability to decide often have questions about MOLST.

For answers to these questions, read MOLST FAQs.

Surveys have shown that people are not dying in the setting of their choice, most do not have advance directives in place, the majority of those being referred to hospice arrive too late to fully benefit, and most fear dying in pain and without dignity or control.

What is the MOLST Program?

The MOLST program is designed to improve the quality of care people receive at the end of life.  The MOLST program is based on the belief that individuals have the right to make their own medical decisions, including decisions about life-sustaining treatment, to describe these wishes to health care providers, and to receive comfort care while wishes are being honored.  MOLST is based on effective communication of patient wishes, documentation of medical orders on a bright pink form and a promise by health care professionals to honor these wishes.

What is the MOLST form?

The MOLST form is a bright pink medical order form that tells others the patient's wishes for life-sustaining treatment.  A health care professional must complete or change the MOLST form, based on the patient's current medical condition, values, wishes and MOLST Instructions.  If the patient is able to make medical decisions, the orders should reflect patient wishes, as best understood by the Health Care Agent or Surrogate.

Must all health care professionals follow the medical orders on the MOLST form?

All health care professionals must follow these orders as the patient moves from one location to another, unless a physician examines the patient, reviews the orders and changes them.

Who should have a MOLST form?

MOLST is generally for patients with serious health conditions (advanced progressive chronic illness or terminal illness) and others who are interested in further defining their care wishes as they are facing the end of life.  The patient or other decision-maker should work with the physician and consider asking the physician to fill out a MOLST form if the patient:

• Wants to avoid or receive any or all life-sustaining treatment
• Wants to allow natural death and avoid efforts to attempt cardiopulmonary resuscitation (CPR) when the heart stops or breathing stops
• Resides in a long-term care facility or requires long-term care services
• Might die within the next year

How is the MOLST form completed?

Completion of the MOLST begins with a conversation or a series of conversations between the patient, the Health Care Agent or the Surrogate and the health care professionals that defines the patient's goals for care, reviews possible treatment options on the MOLST form, and ensures the decision-maker understands the decisions made about life-sustaining treatment.  If a patient is not ready to discuss or make a decision regarding a specific life-sustaining treatment, full treatment will be provided.

Who signs the MOLST form?

A licensed physician must always sign the MOLST form.  If the physician is licensed in a border state, the physician must insert the abbreviation for the state in which he/she is licensed, along with the license number.

Who makes medical decisions on the MOLST form?

Patients are presumed to have the ability to make medical decisions about life-sustaining treatment unless a physician and another health or social service practitioner determines the patient is unable to make such decisions, in accordance with the Family Health Care Decisions Act (FHCDA).

If the patient has the ability to make medical decisions, the patient makes the decision.  If the patient loses the ability to make medical decisions and has a health care proxy, the Health Care Agent makes medical decisions.  If the patient does not have a health care proxy, a Public Health Law Surrogate makes medical decisions.  The FHCDA defines the Surrogate list and their authority.  Surrogates under the FHCDA must meet higher standards in making these medical decisions because the patient did not have a prior discussion.  Thus, completing a health care proxy and having a discussion with your family and health care provider is very important.  For further information on the FHCDA, visit CompassionAndSupport.org and health.state.ny.us.

Can the MOLST be used for patients with mental illness or developmental disabilities? 

The MOLST is approved by the Office of Mental Health and the Office for People with Developmental Disabilities (OPWDD).  Thus, the MOLST can be used for patients with mental illness and patients with developmental disabilities.  If the patient has a developmental disability and does not have the ability to decide, the doctor must follow special procedures and attach the appropriate legal requirements checklist.  Learn more at CompassionAndSupport.org.

What is the difference between a Health Care Proxy/Living Will and the MOLST?

A Health Care Proxy and Living Will are traditional advance directives for all adults 18 years of age and older.  These advance directives are completed ahead of time and only apply when decision-making capacity is lost.  A properly completed MOLST form contains valid medical orders.  MOLST is not intended to replace traditional advance directives like the Health Care Proxy and Living Will.  The MOLST can be used in the community instead of the New York State Nonhospital Do Not Resuscitate (DNR) form.

For more information regarding MOLST in New York State, please visit CompassionAndSupport.org and health.state.ny.us.

Can MOLST be used in other states?  What is POLST?

MOLST is New York State's approved Physician Orders for Life-Sustaining Treatment (POLST) Paradigm Program.  For further information on other states with approved or developing programs, please visit POLST.org. 

to top