MOLST vs. Advance Directives

MOLST stands for Medical Orders for Life-Sustaining Treatment. MOLST is a program designed to ensure that quality end-of-life care aligned with patient preferences is available to all New Yorkers. MOLST is not an advance directive (like a health care proxy or a living will). Advance directives are for everyone 18 years of age and older; MOLST is only for people who are seriously ill or near the end of life. MOLST is for current care not future care. Learn more about the differences between MOLST and advance directives here.

Patients Appropriate for MOLST Discussions

There are five categories of people who should consider using MOLST:

  1. People who might die in the next year, according to their physician
  2. People who live in a nursing home or receive long-term care services at home
  3. People who want to avoid or receive any or all life-sustaining treatment today
  4. People who have one or more advanced chronic conditions or a new diagnosis with a poor prognosis
  5. People who have had two or more unplanned hospital admissions in the last 12 months coupled with increasing frailty, decreasing functionality, progressive weight loss or lack of social support

Completing MOLST Orders

MOLST orders are completed at the end of a thorough conversation or series of conversations between the patient (or authorized decision maker) and their physician. Conversations may include other medical team members, within scope of practice. The MOLST discussion must focus on the person’s current health status, prognosis, goals and preferences for treatment. Learn more about the conversation elements using the nationally-recognized 8-Step MOLST Protocol and the other pages in this section. After the conversation is complete, MOLST orders are documented on a New York State Department of Health MOLST form.

Changing MOLST Orders

MOLST orders must always be based on the person’s current health status, current prognosis, and their goals for care today. MOLST orders must be reviewed and renewed periodically by a physician. MOLST orders can change over time as the person’s condition changes and in line with the person’s goals and preferences. Learn more about how MOLST must be reviewed and renewed and how orders can change over time in the section on Review & Renew.



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The MOLST Update is a Newsletter dedicated to providing up-to-date information on advance care planning, MOLST and eMOLST.