The Massachusetts MOLST Form: Facts and Dangers
MOLST stands for Massachusetts Medical Orders for Life Sustaining Treatment. The MOLST form became law in 2010. The law was passed as part of a growing shift in attitudes across the country about how we view death and end-of-life care. The MOLST form is a standard doctor’s order about getting or not getting care that could save your life or help you. Thirty-five states now have similar laws or are in the process of developing them. Everyone needs to know the dangers of signing a MOLST form.
Once you’ve had a look through the questions and answers, try our 10-question quiz to see how well you know your MOLST. It’s a test you don’t want to fail!
Frequently Asked Questions
The form is a doctor’s order sheet that is printed on brightly colored paper. There are questions on the front and back of the sheet. These questions are about treatments that your doctor may use to keep you alive or help you live longer.
Click here to see what a MOLST Form looks like.
The answers to the questions are based on what care you would want if you needed it. For example, would you want your heart restarted if it stopped beating? Would you want help breathing with a machine if you had trouble breathing on your own? Would you want to be treated with drugs for an infection? Would you want liquid food and fluids through a tube in your stomach if you could not eat? Would you want to use a machine to remove waste products from your blood if your kidneys were not working normally? The form leans toward not treating you instead of giving you care you may need. The choice for less care is always listed first.
On the Massachusetts MOLST website instructions for patients and families, it says: “MOLST is not for everyone. In Massachusetts, patients of any age with a serious advanced illness may discuss filling out a MOLST with their clinician.”
If you have Medicare, starting in 2016, doctors are paid by the government to discuss the MOLST form with you. The doctor is paid for talking with you about end-of-life care during your annual check-up. They also are paid when they talk to you on your first visit after you enroll in Medicare. Medicare guidelines state that you should be told that you are receiving advance care planning services. You have the right to refuse the service.
Because doctors are paid to talk to you about the MOLST form if you have Medicare, you may be asked to sign a MOLST form even if you only have chronic illnesses or are healthy. But as the state website says: “MOLST is not for everyone.” You should only think about signing a MOLST form if you have a serious illness that is now in the advanced stage. You may also feel pressured to sign one, but no one is required to sign a MOLST form.
No. No one can be made to sign a MOLST form. Your doctor may think it is a good idea for you to sign one, but you cannot be made to sign one.
A doctor, nurse practitioner, or physician assistant and the patient both sign the form. If a doctor writes that the patient is not capable of understanding and signing the form, the patient’s health care proxy or agent can sign the form. For a child, the guardian signs the form.
It goes into effect immediately when you sign it. The MOLST form is signed before you may be in danger of a medical emergency, but goes into effect as soon as you sign it. Because it goes into effect right away, it is possible you would not get care that could help you. This is one of the dangers of signing a MOLST form.
Before a MOLST form is signed, your doctor should have a discussion with you about:
- Your illness and what could happen next
- Your values, what is important to you
- The help you might get from treatment and the harm it could do
If you choose to sign the form, sign it only after you have the answers to all of your questions. You should understand all of the information the doctor talked about. If anything is not clear, you should not sign the form. If you feel you are being pushed to sign the form, do not sign it. If the doctor is steering you not to choose care you would like to receive, do not sign the form. You should take all the time you need to fully understand the kind of care you will and will not receive as a result of signing the form.
All Massachusetts doctors, nurses, and emergency staff must follow the orders on the MOLST form when you receive your medical care in Massachusetts. It is a valid form once the patient and doctor sign it. It applies no matter where you are in the state.
The form does have a line where you can write in an expiration date. It does not require an expiration date. If an expiration date is listed on the form, the MOLST form would expire on that date. If expiration date is blank on the form, the MOLST form does not expire.
The person with advanced illness keeps the MOLST form with them. They should keep it in a place where it is easy to find. That may be on the refrigerator, beside the bed, or on the door. It should be carried with them when the leave their home. It should be given to the ambulance driver if they are being taken to the hospital from home. Copies of MOLST forms are valid. A copy should be given to the person’s doctor.
If you are out of state a MOLST form does not apply. Other states may have a POLST law on their books. If they will be traveling, the patient would need to sign that state’s form, as it may be slightly different. Some states may require a patient’s signature, others do not; some states require signatures to be notarized, others do not.
Keep in mind: A MOLST form in another state, although not a medical order, would serve as a document indicative of a patient’s wishes.
A medical order is an order by a doctor for a specific patient who has a specific need at a specfic time. The order is carried out a hospital or facility where the doctor has “admitting privileges.” Admitting privileges at a facility is means the doctor is a member of the staff there. When doctors on are the staff they can give care and treatment to their patients at that facility. A doctor can have admitting privileges at more than one facility. If they do, these facilities are in the same city or next town over.
When a doctor writes an order it is kept in the medical record. The medical record may be paper or electronic. When a patient leaves a facility, the orders written while the patient was there are no longer valid. If the patient goes to another facility, a doctor who has admitting privileges there must see the patient and write new orders.
Although the MOLST form is a medical order, it is different in a number of very important ways:
- When you sign a MOLST form, the medical order is to receive or not receive care that could help you or save your life before you even have a problem that requires treatment. In other words, the MOLST order is signed not when you need it but before you need it.
- The medical order goes into effect immediately. This could be dangerous since it means you may not get care that could help you.
How could that happen? Let’s say you did not wish to have your heart restarted or your breathing helped with a machine near the end of your life and checked those boxes when you signed the MOLST form. Since the MOLST form goes into effect as soon as you sign it, and the orders apply before you need them, the MOLST orders tell others you not to treat you if your heart stops or you need help breathing. MOLST orders apply to any and every situation, some of which might happen well before you were near the end of your life.
For example, you are in a car accident, injured your chest and broke some ribs, and need the help of a machine for a short time to help you breathe better. You might not receive that treatment because you signed a MOLST form. Unlike a regular doctor’s order, the MOLST medical order not to help your breathing with a machine does not depend on a specific need at a specific time, it is an order that applies to all care you want to get or not get whenever you might need care.
- All doctors and nurse must follow MOLST orders even though the doctor who signed the form may not have admitting privileges at the facility where they work.
- The MOLST medical order is valid anywhere in the state.
No, the MOLST form is different from an advance directive. An advance directive is sometimes called a health care proxy form.
The MOLST form is a medical document; the advance directive is a legal one.
The MOLST form is recommended for patients of any age with serious advanced illness. The advance directive is suggested for adults over 18 years, healthy or sick.
The MOLST form is a medical document for life sustaining treatment. The advance directive is a form to legally name someone to act for you in the future only if you are not able to make decisions (unconsciousness, coma, dementia.)
The MOLST form takes effect as soon as you sign it, regardless of your ability to make your own decisions. The advance directive takes effect only when you are not able to make your own decisions about your own health care.
The MOLST form is signed by the doctor and patient; there are no witnesses. The advance directive is signed by the patient and two witnesses of their own choice.
Fore more information about advance directives, read Healthcare Proxies: Securing Your Future Medical Care or the book The Health-Care Decision Guide for Catholics (2nd ed.), both by Pat Stewart, executive director of MCFL.
Living wills are not legal in Massachusetts. They may be used as information about a person’s wishes, but they do not carry the same authority as a medical order like MOLST.
Yes. The MOLST form can be used to either request treatment or refuse treatment about resuscitation, as well as other life saving treatment.