MOLST – Medical Orders for Life-Sustaining Treatment
Emergency medical technicians—the medical staff in an ambulance or fire truck—will not have time to read through an advance directive when they arrive from a 911 call. If the person you care for is frail or seriously ill, the emergency medical technicians need a quick way to know what that person’s wishes are regarding life-support treatments. The same is true for staff in the Emergency Room, and even nurses in the hospital.
The MOLST (which stands for Medical Orders for Life-Sustaining Treatment) is a document that quickly describes your loved one’s wishes. The doctor completes it after a deep conversation with your relative about how much intervention they want—or don’t want—at the end of life. The MOLST then serves, literally, as a doctor’s orders, prescribing end-of-life care for your loved one across all health settings (e.g., the ambulance, the hospital, a skilled nursing facility).
Consider these frequently asked questions (FAQs):
Who needs a MOLST?
People who are frail or seriously ill complete a MOLST with their doctors when they want to be sure that they receive—or don’t receive—certain life support measures. For instance, a person with end-stage cancer going through a difficult chemo regimen might prefer to not to have antibiotics if they get pneumonia. Pneumonia is a gentle way to die, and they might prefer that over living a few more weeks and experiencing death from cancer.
What is in a MOLST?
The MOLST will answer several questions about end-of-life care. For instance:
- Does the patient want CPR (cardiopulmonary resuscitation)?
- Does the patient want to be put on a ventilator (mechanical breathing machine)?
- Would the patient prefer to die at home or in the hospital?
The answer to these and other similar questions will also help medical personnel understand if the person you care for leans more toward wanting everything possible done to stay alive, or leans more toward a natural death.
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Does a MOLST replace an advance directive?
No! They are both documents pertaining to advance healthcare planning, but they have very different purposes.
- An advance directive names a healthcare decision maker (aka a “healthcare agent”) who will step in should the patient become unable to speak for themself. The living will portion may describe general thoughts about life support to help the patient’s agent make choices. But the document itself is not an order for medical staff. All adults should have an advance directive in case they get in an accident or are unable to speak for themselves.
- A MOLST does not name an agent. It is an order from the doctor, created according to the patient’s wishes, telling all medical personnel what they should do or not do if the patient needs life-sustaining treatments. Only the frail or seriously ill need a MOLST.
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How to get a MOLST?
A MOLST is a form completed by the doctor after a conversation with the patient or the patient’s healthcare agent. It has a very specific format and needs to be signed by the physician.
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Where to store the MOLST?
It’s important that the MOLST is easy to find, especially for ambulance personnel responding to a 911 call. They are instructed to look on the refrigerator to see if there is a MOLST and to follow the doctor’s orders on that document. If the doctor has provided a MOLST—often they are printed on a brightly colored paper to make it more easily visible—post it on your loved one’s refrigerator and tell family members it is there so they can point it out.
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Can a MOLST be changed?
It can be voided. Put an “X” through it, throw it away, and say it is no longer valid. But the patient cannot edit it directly by themselves. Since it is a medical order signed by the doctor, any changes to the document must be made by a physician. If the person you care for changes their mind about a procedure or their approach to life support, by all means, have them tell the doctor. The doctor will discuss current preferences and create a new MOLST document.
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