What is MOLST?
MOLST (Medical Orders for Life-Sustaining Treatment) is a discussion and medical orders that give patients more control over their end-of-life care. The document specifies the types of treatments a patient wishes to receive toward the end of life. Completing a MOLST document requires communication between healthcare providers and patients, which enables patients to make more informed decisions about their medical treatment. The MOLST order documents a patient’s decisions in a clear manner and can be quickly understood by all providers, including first responders and emergency medical services (EMS) personnel. As a result, the patient’s wishes can be honored across all settings of care.
When would I need a MOLST form?
The decision to create a MOLST should be discussed with your eligible health care provider. The MOLST form is only intended for a person who is diagnosed with an end stage of a serious life limiting illness such as terminal cancer or is in a condition of advanced chronic progressive frailty.
Does the law require that I complete a MOLST?
No. MOLST is voluntary.
In what setting is the MOLST form used?
The completed signed MOLST form is a set of medical orders that will remain with you if you are transported between care settings, regardless of whether you are in the hospital, at home or in a long-term care facility. The MOLST form is designed to convey your treatment preferences to healthcare providers including paramedics who arrive after 9-1-1 has been called.
Does the MOLST form travel with me between settings of care?
Yes, the MOLST form is designed to be a standard form that may be accepted by Connecticut health care providers. As a legal medical order, it will be honored by EMS, hospitals, long term care facilities, home hospice providers, and is included in your medical records.
Does the MOLST form need to be signed?
Yes. You, or if you are incapacitated, your Legally Authorized Representative (LAR) and your Physician (MD/DO) Advanced Practice Registered Nurse (APRN) or Physician Assistant (PA) must sign the form in order for it to be a medical order that is understood and followed by other health care providers, including EMS personnel.
What is a Legally Authorized Representative (LAR)?
As defined in Conn. Gen. Stat. § 19a-580h, a legally authorized representative (LAR) is someone who is legally authorized to make decisions in accordance with your wishes if you are incapable of making decisions. A LAR can be your parent, guardian, health care representative, or conservator.
- A health care representative is appointed in writing under Conn. Gen. Stat. §§ 19a-576 and 19a-577 to make any and all health care decisions on a person’s behalf when the person is unable to communicate his or her decisions about medical care.
What if I am no longer able to communicate my wishes and I do not have a MOLST?
Your eligible provider (MD/DO, APRN or PA) can complete the MOLST form after a conversation with your LAR based on their understanding of your wishes.
I have a DNR Bracelet. Will it still be honored by Emergency Medical Services (EMS)?
Yes, if you have an orange plastic DNR Bracelet or a metal DNR bracelet from the Connecticut College of Emergency Physicians, this is still a valid method to communicate a person’s wishes to forgo cardio-pulmonary resuscitation. Learn more about Connecticut’s DNR Program.
If I have a MOLST, do I still need a living will or other advance directive?
It is recommended that everyone over 18 have a living will or other advance directive and appoint a health care representative. The MOLST form complements advance directives. It documents your decisions following a conversation between you and your eligible health care provider about the type of medical care you want or do not want, and under what conditions.
Is MOLST the same as an advance directive?
No, MOLST does not replace an advance directive. An advance directive can provide significantly more detail about an individual’s wishes and preferences for treatment.
Where is the MOLST form kept?
Your MOLST is your personal property. If you live at home, you should keep a printed version of the form in a location where it can easily be seen. The ideal place is on your refrigerator or on the back of your door where EMS personnel will look for it first.
If you reside in a long-term care or other facility, your MOLST form may be kept in your medical chart, and/or on the back of your bedroom door.
Where can I get a MOLST form?
A PDF version of the MOLST is available on the DPH website, and eligible health care providers may have paper forms.
Talk to your eligible health care provider who can help you in understanding and completing the form. Remember, a MOLST must be signed by you (or your LAR) and your provider to be valid. If you want additional copies of your MOLST, you may print a copy or request a copy from your provider.
When does the MOLST form expire?
The MOLST form does not expire. Reviewing the MOLST form with patients frequently is a best practice.
Does the MOLST form travel with the patient between settings of care?
Yes, the MOLST form is designed to be a standard form that may be accepted by all providers across the state. As a legal medical order, it can be honored by providers and facilities such as but not limited to EMS, hospitals, long-term care facilities, home care and hospice providers.
Outside of Connecticut, the MOLST instructions may be honored in some states but not in others. However, a MOLST form is always a good record of a person’s treatment decisions. Patients who reside in (or spend time regularly in) multiple states are recommended to discuss MOLST/POLST/POST orders with clinicians in both states.
Why isn’t the MOLST form considered an advance directive?
The MOLST form is not an advance directive because it is a medical document that contains actionable medical orders that are effective immediately based on a patient's current medical condition. Advance directives, including living wills and the appointment of health care representatives, are legal documents that are effective only after the patient has lost capacity. In other words, a health care representative can make decisions for a person only after he or she has been determined to lack capacity; a living will is relevant only after the patient can no longer be consulted. A MOLST form, on the other hand, is a medical document signed by both the clinician and the patient, and is effective as soon as it is signed, regardless of a patient’s capacity to make decisions.
I am a health care professional who is not an eligible provider (e.g. RN, LPN, LCSW, MSW, etc.). How can I support an individual who is interested in MOLST?
- All health care professionals can educate themselves on what MOLST is, and how it is distinct from other advance directives (e.g. living will, DNR). Education can help support the patients served in a practice setting.
- Encourage the interdisciplinary team to be better informed about MOLST. This can include promptingphysicians, APRNS, and PAs to take the eligible provider training.
- Connect an interested patient with their eligible provider who can initiate a discussion regarding their end-of-life treatment preferences.
Where can I find more information about MOLST?
Please visit the DPH MOLST website for additional information. There is also a course specific to EMS providers available on CT TRAIN.