MOLST is an

acronym An acronym is a word or name formed from the initial components of a longer name or phrase. Acronyms are usually formed from the initial letters of words, as in '' NATO'' (''North Atlantic Treaty Organization''), but sometimes use syllables, a ...

for Medical Orders for Life-Sustaining Treatment. The MOLST Program is an initiative to facilitate end-of-life medical decision-making in

New York State New York, officially the State of New York, is a U.S. state, state in the Northeastern United States. It is often called New York State to distinguish it from its largest city, New York City. With a total area of , New York is the List of U.S. ...

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and

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, that involves use of the MOLST form. Most other U.S. states have similar initiatives, such as

Physician Orders for Life-Sustaining Treatment POLST (Physician Orders for Life-Sustaining Treatment) is an approach to improving end-of-life care in the United States, encouraging providers to speak with the severely ill and create specific medical orders to be honored by health care workers d ...

. In New York state, the MOLST form is
New York State Department of Health
form
DOH-5003
. MOLST is for patients such as a terminally ill patient, whether or not treatment is provided. N.Y. Public Health Law section 2994-d
/ref> For this example, assume the patient retains medical decision-making capacity and wants to die naturally in a residential setting, not in the Capacity (law)">capacity and wants to die naturally in a residential setting, not in the intensive-care unit of a hospital on a ventilator">intensive-care unit">Capacity (law)">capacity and wants to die naturally in a residential setting, not in the intensive-care unit of a hospital on a ventilator with a

feeding tube Eating (also known as consuming) is the ingestion of food, typically to provide a heterotrophic organism with energy and to allow for growth. Animals and other heterotrophs must eat in order to survive — carnivores eat other animals, her ...

. Using MOLST, with the informed consent of the patient, the patient's doctor could issue medical orders for life-sustaining treatment, including any or all of the following medical orders: provide comfort measures (

palliative care Palliative care (derived from the Latin root , or 'to cloak') is an interdisciplinary medical caregiving approach aimed at optimizing quality of life and mitigating suffering among people with serious, complex, and often terminal illnesses. Wi ...

) only; do not attempt resuscitation (allow natural death); do not

intubate Tracheal intubation, usually simply referred to as intubation, is the placement of a flexible plastic tube into the trachea (windpipe) to maintain an open airway or to serve as a conduit through which to administer certain drugs. It is frequently ...

; do not hospitalize; no

; no IV fluids; do not use

antibiotic An antibiotic is a type of antimicrobial substance active against bacteria. It is the most important type of antibacterial agent for fighting pathogenic bacteria, bacterial infections, and antibiotic medications are widely used in the therapy, ...

s; no

dialysis Dialysis may refer to: *Dialysis (chemistry), a process of separating molecules in solution **Electrodialysis, used to transport salt ions from one solution to another through an ion-exchange membrane under the influence of an applied electric pote ...

; no transfusions. The orders should be honored by all health care providers in any setting, including

emergency responders Emergency services and rescue services are organizations that ensure public safety and health by addressing and resolving different emergencies. Some of these agencies exist solely for addressing certain types of emergencies, while others deal w ...

who are summoned by a

9-1-1 , usually written 911, is an emergency telephone number for the United States, Canada, Mexico, Panama, Palau, Argentina, Philippines, Jordan, as well as the North American Numbering Plan (NANP), one of eight N11 codes. Like other emergency n ...

telephone call after the patient loses medical decision-making capacity.New York State Department of Health MOLST web page
/ref> 0 NYCRR § 400.21(b)(6)/ref>

MOLST Program in New York State

The MOLST Program is a New York State initiative that facilitates end-of-life medical decision-making. One goal of the MOLST Program is to ensure that decisions to withhold or withdraw life-sustaining treatment are made in accordance with the patient's wishes, or, if the patient's wishes are not reasonably known and cannot with reasonable diligence be ascertained, in accordance with the patient's best interests. Patricia "Pat" Bomba, MD, has spearheaded the MOLST Program since its inception. Dr. Bomba is a Vice President at

Excellus BlueCross BlueShield Blue Cross Blue Shield Association (BCBS, BCBSA) is a federation, or supraorganization, of, in 2022, 34 independent and locally operated BCBSA companies that provide health insurance in the United States to more than 106 million people. It was f ...

.Patricia A Bomba MD, FACP
/ref> Information about the MOLST Program can be found on the website that Dr. Bomba runs called www.compassionandsupport.org.

Legal basis in New York State

Under New York

common law In law, common law (also known as judicial precedent, judge-made law, or case law) is the body of law created by judges and similar quasi-judicial tribunals by virtue of being stated in written opinions."The common law is not a brooding omniprese ...

, health care providers may withhold or withdraw life-sustaining treatment from a patient who is dying and currently lacks the capacity to make his or her own medical decisions if doing so is based upon

clear and convincing evidence In a legal dispute, one party has the burden of proof to show that they are correct, while the other party had no such burden and is presumed to be correct. The burden of proof requires a party to produce evidence to establish the truth of facts ...

of the patient's wishes.''In re Westchester County Med. Ctr. ex rel. O’Connor, 72 N.Y.2d 517''
/ref> Since 1987, New York has had a Do Not Resuscitate (DNR) law allowing surrogates to make decisions regarding

cardiopulmonary resuscitation Cardiopulmonary resuscitation (CPR) is an emergency procedure consisting of chest compressions often combined with artificial ventilation in an effort to manually preserve intact brain function until further measures are taken to restore spon ...

on behalf of an adult patient who lacks medical decision-making capacity. .Y. laws of 1987, chapter 818/ref> In 1991, the law was amended to authorize non-hospital orders not to resuscitate. .Y. laws of 1991, chapter 370, section 17, codified in former N.Y. Public Health Law section 2977/ref> Based upon this law, th
New York State Department of Health
created a "standard form" to issue a non-hospital order not to resuscitate
DOH-3474
, which is still in use today. In 2005, the law was amended to give th
New York State Department of Health
authority to issue "alternative forms" for issuing non-hospital orders not to resuscitate in Monroe and

Onondaga Onondaga may refer to: Native American/First Nations * Onondaga people, a Native American/First Nations people and one of the five founding nations of the Iroquois League * Onondaga (village), Onondaga settlement and traditional Iroquois capi ...

Counties.N.Y. laws of 2005, chapter 734
, adding a subdivision (13) to former N.Y. Public Health Law section 2977] This established MOLST as a pilot program. In 2006, the law was amended to allow such "alternative forms" to be used to issue non-hospital Do Not

Intubate Tracheal intubation, usually simply referred to as intubation, is the placement of a flexible plastic tube into the trachea (windpipe) to maintain an open airway or to serve as a conduit through which to administer certain drugs. It is frequently ...

(DNI) orders.N.Y. laws of 2006, chapter 325
This was necessary because in New York State,

emergency medical services Emergency medical services (EMS), also known as ambulance services or paramedic services, are emergency services that provide urgent pre-hospital treatment and stabilisation for serious illness and injuries and transport to definitive care. ...

personnel may only honor a DNR order in the event of a

cardiac The heart is a muscular organ found in most animals. This organ pumps blood through the blood vessels of the circulatory system. The pumped blood carries oxygen and nutrients to the body, while carrying metabolic waste such as carbon di ...

respiratory arrest Respiratory arrest is a sickness caused by apnea (cessation of breathing) or respiratory dysfunction severe enough it will not sustain the body (such as agonal breathing). Prolonged apnea refers to a patient who has stopped breathing for a long pe ...

and would still

a patient with a DNR order unless the patient's heart or breathing has completely stopped.New York State Department of Health Bureau of Emergency Medical Services Policy 11-02
/ref> In 2008, MOLST ceased to be a pilot program when the law was amended to authorize use of the MOLST form as a non-hospital DNR and DNI order statewide.N.Y. laws of 2008, chapter 197
In 2010, along with passage of the Family Health Care Decisions Act, the legal authority for MOLST was moved from N.Y. Public Health Law Article 29-B to a new N.Y
Public Health Law Article 29-CCC
N.Y. laws of 2010, chapter 8
adding a ne
N.Y. Public Health Law section 2994-dd
/ref> Under current law, the MOLST form can be used to issue a non-hospital DNR and DNI order in New York State, and those orders must be honored by

personnel,

home care Homecare (also spelled as home care) is health care or supportive care provided by a professional caregiver in the individual home where the patient or client is living, as opposed to care provided in group accommodations like clinics or nursing ho ...

services personnel, hospice personnel and hospital emergency services personnel.N.Y. Public Health Law section 2994-bb
/ref> Physicians may also use the form for any patient in any setting to issue any orders for life-sustaining treatment.OMH letter, August 23, 2010
/ref>OPWDD memo, January 21, 2011
Coverage for an initial preventive physical examination under Medicare Part B includes verbal or written information regarding a patient's ability to prepare a MOLST form and the physician's willingness to issue orders on a MOLST form. 2 U.S.C. section 1395x(ww)/ref> New York Public Health Law section 2997-c requires the "attending health care practitioner" to offer to provide patients with a terminal illness with information and counseling regarding palliative care and end-of-life options appropriate to the patient.New York State Department of Health Palliative Care Information Act web page
/ref>

References

{{reflist Palliative care Health law in the United States Hospice