Medical Orders for Life-Sustaining Treatment (MOLST)
Honoring patient preferences is a critical element in providing quality end-of-life care. To help physicians and other health care providers discuss and convey a patient's wishes regarding cardiopulmonary resuscitation (CPR) and other life-sustaining treatment, the Department of Health has approved a physician order form (DOH-5003), Medical Orders for Life-Sustaining Treatment (MOLST) , which can be used statewide by health care practitioners and facilities. MOLST is intended for patients with serious health conditions who:
- Want to avoid or receive any or all life-sustaining treatment;
- Reside in a long-term care facility or require long-term care services; and/or
- Might die within the next year.
Completion of the MOLST begins with a conversation or a series of conversations between the patient, the patient's health care agent or surrogate, and a qualified, trained health care professional that defines the patient's goals for care, reviews possible treatment options on the entire MOLST form, and ensures shared, informed medical decision-making. Although the conversation(s) about goals and treatment options may be initiated by any qualified and trained health care professional, a licensed physician must always, at a minimum: (i) confer with the patient and/or the patient's health care agent or surrogate about the patient's diagnosis, prognosis, goals for care, treatment preferences, and consent by the appropriate decision-maker, and (ii) sign the orders derived from that discussion.
The MOLST form is one way of documenting a patient's treatment preferences concerning life-sustaining treatment – providers may choose to use other forms. However, under State law, the MOLST form is the only authorized form in New York State for documenting both nonhospital DNR and DNI orders. In addition, the form is beneficial to patients and providers as it provides specific medical orders and is recognized and used in a variety of health care settings.
In hospitals and nursing homes, the form may be used to issue any orders concerning life-sustaining treatment. In the community, the form may be used to issue nonhospital Do Not Resuscitate (DNR) and Do Not Intubate (DNI) orders, and in certain circumstances, orders concerning other life-sustaining treatment. The signed MOLST form should be transported with patients as they travel to different health care settings. The medical orders on the form need not be re-issued by the patient's new health care provider, but should be reviewed and may be revised by a physician, when the patient transitions to a different setting and when the patient's preferences and/or medical conditions change.
The Department updated the MOLST form in June of 2010 to make it more user-friendly and to align the form with the Family Health Care Decisions Act (FHCDA) and other provisions of Chapter 8 of the Laws of 2010 that went into effect on June 1, 2010.
In addition to the MOLST form itself, the Department has developed legal requirements checklists and frequently asked questions. These checklists are NOT intended for use with patients with developmental disabilities who lack medical decision-making capacity, or patients with mental illness in a mental hygiene facility. The checklists are intended to assist providers in satisfying the complex legal requirements associated with decisions concerning life-sustaining treatment for all other patients. They are guidance documents, and the use of these checklists is not mandatory. However, providers that do not use the checklists must use an alternative method for assuring that they adhere strictly to all legal requirements for completing the form, including requirements related to securing informed consent to the medical orders from the proper person, making the clinical judgments necessary to support orders withholding or withdrawing life sustaining treatment and, where applicable, securing ethics committee approval and witnesses to the consent.
MOLST legal requirements checklists and general instructions for adult patients are:
- MOLST Adult General Instructions and Glossary (3/2012) (PDF, 114KB, 6pg.)
- MOLST Checklist 1 - adult with capacity any setting (5/1/13) (PDF, 49KB)
- MOLST Checklist 2 – adult with health care proxy any setting (5/1/13) (PDF, 91KB)
- MOLST Checklist 3 - adult with FHCDA surrogate (3/2012) (PDF, 95KB, 4pg.)
- MOLST Checklist 4 - adult without FHCDA surrogate (12/1/10) (PDF, 58KB, 4pg.)
- MOLST Checklist 5 - adult without capacity in the community (12/1/10) (PDF, 59KB, 4pg.)
The MOLST legal requirements checklist for minor patients is:
- MOLST Checklist for Minor Patients and Glossary (3/2012) (PDF, 120KB, 7pg.)
Frequently Asked Questions regarding MOLST:
A Note Regarding Use of MOLST for Persons With Mental Illness or Developmental Disabilities Who Lack Decision-Making Capacity:
The MOLST form has been approved by the Office of Mental Health (OMH) and the Office for People with Developmental Disabilities (OPWDD) for use as a nonhospital DNR/DNI form for persons with developmental disabilities or persons with mental illness, including persons who are incapable of making their own health care decisions or who have a guardian of the person appointed pursuant to Article 81 of the Mental Hygiene Law or Article 17-A of the Surrogate's Court Procedure Act. Please note: The OPWDD has approved a NEW checklist. This checklist MUST be attached to the MOLST form, in order for the form to be used for persons with developmental disabilities who are incapable of making their own health care decisions or who have a guardian of the person appointed pursuant to Article 81 of the Mental Hygiene Law or Article 17-A of the Surrogate's Court Procedure Act. The New OPWDD checklist can be found here. A checklist for persons with mental illness in mental hygiene facilities, who are incapable of making their own health care decisions or who have a guardian of the person appointed pursuant to Article 81 of the Mental Hygiene Law or Article 17-A of the Surrogate's Court Procedure Act, is under development.
The MOLST form should be printed on bright "pulsar" pink, heavy stock paper. Hard copies of the card stock pink form (with all four pages printed landscape/double-sided on a single 11" X 17" sheet folded in the middle) can be ordered using a form that can be downloaded from http://www.compassionandsupport.org/.