For Health Professionals

Guidance for using MOLST forms with patients

Based on the ethical and legal principles of respect for patient autonomy and self-determination, the Massachusetts MOLST process and form offer an appropriate way to meet the standard of care for communicating patient preferences about life-sustaining treatment across health care settings. The MOLST form provides a way for patients to exercise their rights to either accept or refuse certain medically indicated treatments.

Signing a MOLST form is one possible outcome of broader advance care planning discussions between a patient and his or her clinician and loved ones. The MOLST form translates a patient’s expressed preferences about life-sustaining treatment into actionable medical orders.

Once signed, the MOLST form is valid and immediately actionable, regardless of whether the patient has decision-making capacity at the time treatment could be given.

Click on the following links to become more familiar with the details of using MOLST with your patients:

Which patients should consider using a MOLST form?
The MOLST form is suitable for patients of any age who are nearing the end of life with a serious advancing medical condition.

Authority to honor the MOLST form
The Massachusetts MOLST program was mandated by legislation in the Acts of 2008. 

Signing the MOLST form
A physician, nurse practitioner or physician assistant signs the MOLST form along with the patient or health care agent if the patient lacks capacity or a guardian (if authorized to the extent of Massachusetts law). 

Content of the MOLST form
The MOLST form contains options to request or refuse a range of life-sustaining medical treatments.

Portability of the MOLST form
The signed MOLST form belongs to the patient.  Instruct patients and caregivers about the importance of keeping the MOLST form where it is easy to see (on the refrigerator, by the bedside, on the back of a door).

Reviewing the MOLST form
The MOLST form does not expire, but it needs to be re-discussed and reviewed periodically with patients under certain circumstances.  Patients can request to change or void their MOLST form at any time.

Changing a patient’s MOLST instructions
To change a patient's MOLST instructions, the outdated form must be voided and a new MOLST form must be established.

MOLST form — Review of each section
Each section of the MOLST form is reviewed in detailed here.