Do I need a POLST or MOLST?

A POLST is a Physician Orders for Life-Sustaining Treatment. In the state of New York, it is more commonly referred to as a MOLST (a Medical Order for Life-Sustaining Treatment). The document is a bright pink form that specifically details a person’s wishes regarding end of life care. It is signed by both the patient and his or her treating physician or a nurse practitioner. The patient specifically states preferences of care which is converted into an actionable plan. The plan is then integrated into his/her medical record.

About the MOLST Program

The MOLST program began in the year 2001. It was started as a community-driven initiative in Rochester County to improve end‑of-life care. The program collaborated with the New York State Department of Health (“NYSDOH”) in 2004. The NYSDOH then approved the use of MOLST in all health care facilities and for use in all counties in 2005.

About the Document

This document is generally presented by a health care professional upon a diagnosis of terminal illness to residents residing in a long-term care facility or to seriously ill or frail individuals. It is a legally binding instrument. A health care agent, surrogate or guardian may also sign the form on behalf of the patient or disabled person, or a parent may sign for a minor child.

The form has sections to specifically address the following:

1. Resuscitation, when there is no pulse or the patient is not breathing;
2. Intubation and mechanical ventilation;
3. Treatment guidelines for oxygen and airway obstruction;
4. Future hospitalization and transfer;
5. Antibiotics and medication;
6. Fluid administration (including a trial period); and
7. Other instructions for starting and stopping treatment such as dialysis or transfusions.

Confusion often exists as to whether a MOLST replaces the need for advance directives such as a Health Care Proxy or Living Will. To clarify, a MOLST is not an advance directive for future care. Instead, it is a treatment plan based on your current health and prognosis. This document works together to supplement your advance directives but it is not at all a substitute. Advance directives are safeguards that all adults (regardless of health condition) should have. A Health Care Proxy allows your designated agent to sign a MOLST on your behalf if you are unable to do so at that time.

It should be noted that Emergency Medical Service (EMS) can only withhold the resuscitation of a patient in his or her home based on a MOLST order. Any directives regarding the withholding of life-sustaining treatment in a Living Will is only valid in a health care facility such as a hospital or nursing home.

Common MOLST Uses

Although there is no “terminally ill” requirement for the execution of a MOLST, it is most commonly used in end-of-life situations and signed in a medical facility. You can request the form from your health care provider or order it directly from the following link: https://www.health.ny.gov/publications/4208/pdf/4208_order_form.pdf.