Updated MOLST Form and Guidance Documents Released
(May 5, 2025) The Department of Health (DOH) released long-awaited updates to the Medical Orders for Life-Sustaining Treatment (MOLST) form and related documents last week. The changes in the form are aimed at making it more user-friendly and straightforward. Along with the updates to the form, the Department has updated the instructions and legal requirements checklists for the MOLST process. The updates were announced in a Dear Administrator Letter (DAL), which emphasizes that "[e]xisting MOLST forms that have already been completed remain valid." In addition, the changes to the MOLST form have been incorporated into the electronic MOLST application (eMOLST).
The changes in the recently released MOLST form include the following:
- A more concise introductory paragraph.
- New phrasing of the intubation and mechanical ventilation options. Although intended to clarify the distinct options of non-invasive ventilation versus intubation with mechanical ventilation, the new formulation raises questions about the ability to choose a trial of intubation and mechanical ventilation.
- Shifting the future hospitalization/transfer orders to the second page and eliminating the unconditional "do not send to the hospital option," thereby always allowing transfer to a hospital when pain and severe symptoms cannot be controlled.
- Changing the decision-maker for minor patients to "Family Health Care Decisions Act Surrogate for minor," instead of "Parent/Guardian."
- Modifying the Review and Renewal page to mandate (rather than encourage) review at least every 90 days.
- Adding a paragraph that limits the health care agent's or surrogate's authority to change a patient's decision. This paragraph is unclear and raises questions about the ability of a decision-maker to change decisions based on changes in the patient's condition.
The Department has committed to working with stakeholders from the MOLST Statewide Implementation Team to develop education and guidance to support the roll-out of the new form.
MOLST is intended for patients with serious health conditions who:
- want to avoid or receive any or all life-sustaining treatment;
- reside in a long-term care facility or require long-term care services; and/or
- might die within the next year.
The MOLST form is one way of documenting a patient's treatment preferences and related orders concerning life-sustaining treatment. Under State law, the MOLST form is the only authorized form for documenting both a non-hospital do not resuscitate (DNR) order and a non-hospital do not intubate (DNI) order. The form also provides specific medical orders relating to hospitalization and other interventions (e.g., dialysis, intravenous fluids, etc.) and is recognized and portable among various health care settings. It must be completed by a health care professional and signed by a physician, nurse practitioner, or physician assistant, after a conversation or series of conversations among the patient and/or their decision-maker and a qualified health care professional concerning the patient's goals for care, prognosis, and the risks and benefits of various interventions.
To support the MOLST process and ensure adherence to legal requirements related to life-sustaining treatment decisions, the Department has developed instructions and legal requirements checklists, available on the Department's MOLST website here. DOH's checklists are guidance documents, and the use of these checklists is strongly encouraged, but not mandatory. The Office for People with Development Disabilities (OPWDD) has created an additional checklist for any patient with an intellectual or developmental disability who lacks medical decision-making capacity and does not have a health care proxy. The OPWDD checklist is mandatory and must be attached to the MOLST form in order for the form to be valid.
Contact: Karen Lipson, klipson@leadingageny.org