MOLST in Massachusetts is based on the premise that individuals have the right to accept or refuse medically indicated treatment, including life-sustaining treatments; and the ethical principle of respect for patient autonomy; and legal principle of patient self-determination.
MOLST is a Medical Order - different from an advance directive because it is based on a person's current heatlh status and is effective immediately upon signature, whether or not a person retains capacity or has lost capacity to make medical decisions for themselves. Use of the MOLST form is supported in Massachusetts as a “clinical standard of care for communicating patient preferences regarding life-sustaining treatment options.” Health professionals are encouraged to honor MOLST forms as bona fide medical orders.
Resources for Legal Professionals:
- One-page Legal Guide to the Massachusetts MOLST form.
- MOLST News Brief: Legal Focus - June 2014
- Lawyers' Frequently Asked Questions about MOLST and responses.
- Differences between MOLST and a Health Care Proxy form - a Health Care Proxy form is the only advance directive recognized by Massachusetts statute. Every adult in Massachusetts aged 18 and older should use a health care proxy form to appoint their health care agent, whether they are healthy or sick.
- Glossary - The words and terms used to discuss health care planning are often confused by the public and health care professionals alike. These definitions may be helpful.
- MOLST Legal Overview - This set of narrated Power Point slide presentations provides a MOLST Legal Overview. The overview involves a short introduction and three segments that cover:
MOLST Developmental Timeline
- 1990 - United States Congress passed the Patient Self-Determination Act to encourage Americans to put their preferences for life-sustaining medical care into writing.
- 2004 - National POLST Task Force convenes with mission to "facilitate POLST Paradigm Programs in every state."
- 2008 - Massachusetts Acts of 2008 mandates establishment of a "POLST Paradigm" demonstration program in the Commonwealth.
- February 2010 - Massachusetts MOLST Demonstration program is implemented in Worcester area.
- February 2010 - MA DPH Circular Letter: DHCQ 10-02-529 supports MOLST use.
- 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.
- 2011 - MOLST Demonstration Report recommends statewide expansion of MOLST.
- March 2012 - Massachusetts Department of Public Health promotes statewide MOLST expansion in Circular Letter DHCQ 12-3-560.
- 2012 - Statewide expansion of MOLST use begins in Massachusetts.
- 2014 - MOLST in use in clinical care institutions statewide.