MOLST (Medical Orders for Life-Sustaining Treatment) is a discussion and written medical orders that help health care providers communicate about a patient's care regarding life-sustaining treatments. The MOLST form documents patients’ decisions in a clear manner that can be quickly understood by all providers, including first responders and emergency medical services (EMS) personnel.
MOLST is based on an individual's right to accept or refuse medical treatment, including treatments that might extend life. For example, a MOLST could say whether a patient wishes to have CPR if their heart has stopped.
Connecticut MOLST History
In 2014, Special Act 14-5 “An Act Concerning the Department of Public Health's Recommendations Regarding Medical Orders For Life-Sustaining Treatment” was passed. Special Act 14-25 gave the Connecticut Department of Public Health the authority to create a pilot program in selected areas of the state.
The MOLST pilot program was launched on April 16, 2015, National Health Care Decisions Day. The pilot served 142 individuals in thirteen facilities and hospitals throughout the State and provided valuable guidance that informed subsequent decision making.
On June 26, 2017, Governor Malloy signed into law Senate Bill 938, Public Act 17-70 “Act Concerning the Department of Public Health’s Recommendations for the state-wide adoption of the Medical Orders for Life Sustaining Treatment”, which authorizes the use of these medical orders throughout Connecticut.
What is POLST
The Connecticut MOLST was developed from the national Physician Orders for Life Sustaining Treatment (POLST) Paradigm. MOLST is Connecticut’s adaptation of the National POLST Collaborative.Link to the National POLST Collaborative Website
MOLST and Advance Care Planning
Advance care planning is a comprehensive approach to an expression of a person’s intentions for end-of-life care. MOLST can be one element of advance care planning, but a MOLST is not an advance directive, like a living will. While it is recommended that all adults aged 18 and older complete advance planning documents, MOLST is intended for people who know they are nearing the end of life, or those with an advanced chronic progressive frailty.MOLST is Not for Everyone
In Connecticut, individuals nearing the end stage of a life-limiting illness or in a state of advanced progressive frailty may choose to fill out a MOLST with their clinician. MOLST is strictly voluntary.Patient Autonomy
Based upon respect for patient autonomy and self-determination, MOLST is based on an individual's right to choose whether to accept or refuse medical treatment, including treatments that might extend life.
The MOLST Conversation
A MOLST conversation involves an eligible health care provider engaging with a patient (and if the patient chooses, their loved ones) about end-of-life care, to determine the patient’s values and wishes. This conversation may require several visits to convey empathy, promote patient autonomy, and provide necessary information. The resulting medical order reflects the patient’s wishes and goals of care for full medical treatment, limited medical treatment, or comfort measures only.