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Policy & Research


  • 1990 - US Congress passes the Patient Self-Determination Act to encourage Americans to put their preferences for life-sustaining medical care into writing.
  • 2008 -  The Massachusetts legislature enacts Section 43 of its Acts of 2008 to require the establishment of a Massachusetts MOLST demonstration program. Section 43 reads as follows: Notwithstanding any general or special law to the contrary, the executive office of health and human services, in consultation with the commission on end-of-life care established by section 480 of chapter 159 of the acts of 2000, shall establish a pilot program to test the implementation of the physician order for life-sustaining treatment paradigm program to assist individuals in communicating end-of-life care directives across care settings in at least 1 region of the commonwealth. The pilot program shall include educational outreach to patients, families, caregivers and health care providers regarding the physician order for life-sustaining treatment paradigm program. The executive office of health and human services, in conjunction with the end-of-life commission, shall develop measures to test the success of the pilot program and make recommendations for the establishment of a state-wide program.
  • February 2010 MA Department of Public Health Circular Letter: DHCQ 10-02-529 supports the use of the MOLST process and form to meet the “standard of care for communicating patient preferences regarding life-sustaining treatment options.”
  • March 2012 - MA Department of Public Health Circular Letter DHCQ 12-3-560 promotes statewide MOLST expansion. 
  • The Health Information Portability and Accountability Act allows health care providers to access MOLST information when necessary for treatment.  Learn more about this federal privacy rule (HIPAA) that gives Americans more control over their health information.



  • October 2010 - Massachusetts Expert Panel on End-of-Life Care recommends statewide expansion of MOLST in report: Patient Centered Care and Human Mortality - The Urgency of Health System Reforms to Ensure Respect for Patients