A Medical Order for Life Sustaining Treatment (“MOLST”) is a direction by a terminally ill patient to require or refuse resuscitative and life-sustaining measures.  It is entirely voluntary and only comes into effect in the event that the patient becomes unable to make such decisions in the future.  It is intended to work together with or supplement other advance directives, such as a living will, health care power of attorney, or health care proxy. 

While MOLSTs have been authorized since mid-2012, the Department of Health only released regulations and the standard MOLST form late last year.  The form is required to be printed on neon pink paper, so that it is easily recognizable in a patient’s medical records, and it includes directions that aren’t necessarily in other advance directives (such as intubation, antibiotic use, and feeding tubes). 

Beginning January 1, 2014, hospitals, nursing facilities, assisted living residences, hospices, kidney dialysis centers, and home health agencies are required to accept a MOLST form, update it if appropriate, and provide each terminally-ill patient that doesn’t have one the opportunity to complete one during the admission process.  Additionally, beginning on January 1, 2014, nursing homes and assisted living facilities must offer existing residents an opportunity to complete a MOLST form, and hospitals must offer each patient the opportunity to complete a form before discharging or transferring them to another facility, even if the resident/patient is not terminally ill. 

The MOLST form must be executed by the patient (or an authorized party) and a qualified health care provider.  From an estate planning perspective, health care agents designated in a health care power of attorney may sign a MOLST form on the patient’s behalf.  Therefore, the directives outlined in the MOLST form are important topics for individuals to discuss with their designated health care agent prior to incapacity. 

The MOLST form and additional information is available through the Rhode Island Department of Health: http://www.health.ri.gov/lifestages/death/about/medicalordersforlifesustainingtreatment/