Medical Orders for Life Sustaining Treatment (MOLST)

by Bonnie Kraham, Esq.

Medical orders for life-sustaining treatment (MOLST) forms are medical directives signed by a doctor and used to convey a patient’s wishes regarding life-sustaining treatment. The purpose is to improve the quality of care seriously ill people receive at the end of life.

The form does not replace a health-care proxy and living will, which are completed in advance and apply only when you can’t speak for yourself. In a health-care proxy, you appoint an agent to make medical decisions for you if you no longer can. In a living will, you state your wishes regarding life-sustaining treatment.

By contrast, a MOSLT form is only for the seriously ill, applies in the present and contains medical orders based on the patient’s wishes after discussions with a doctor.

A survey by BlueCross revealed that only 42 percent of those surveyed had chosen a health-care proxy, so a majority are without an advance directive for medical decisions.

A new law addresses the gap in advance directives. The Family Health Care Decisions Act, effective June 1, allows a close family member or friend to make health decisions for incapacitated loved ones who do not have a health-care agent or didn’t previously make such decisions. New York now joins most of the country in allowing loved ones to make health-care decisions for the incapacitated at the end of life.

The MOLST form reflects the new law in that surrogates (agents) as well as the patient or patient’s health-care proxy can communicate the patient’s desires for life-sustaining treatment.

The Family Health Care Decisions Act designates, in order of priority, who can act as a surrogate for the adult incapacitated person. The first surrogate is the spouse or domestic partner. The list then includes adult child, parent, sibling, and last, a close friend. If the court has appointed a guardian, that person takes priority.

Decisions are based on the patient’s wishes or the patient’s best interests if his or her wishes are unknown.

The MOSLT form and Family Health Care Decisions Act are advancements to honor each person’s end-of-life desires regarding medical treatment.

However, it can’t be emphasized enough — the best way to honor desires regarding end-of-life medical treatment is to consult with a New York elder law attorney to complete a health-care proxy and living will in advance, while you’re well.