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Health Care Advanced Directive: The Massachusetts MOLST Form

In addition to maintaining up-to-date estate planning documents, individuals with serious advanced illnesses or specific wishes regarding health care decisions should consider executing a Medical Orders for Life-Sustaining Treatment (MOLST) form.

A Massachusetts MOLST form is a medical order signed by both a clinician and patient which specifies the patient’s medical decisions regarding life-sustaining or end-of-life medical treatment. It is a directive that applies across all health care settings in Massachusetts, providing doctors, nurses, EMTs, and other health care providers with consistent instructions in the event medical treatment is needed. Ideally, the completed MOLST form should be kept with the patient at all times.

MOLST versus Health Care Proxy; having both is recommended.

A Health Care Proxy is a legal document that names a health care agent to make future medical decisions if a person becomes incapacitated and cannot make his or her own medical decisions. Conversely, a MOLST form is a medical order for current medical illnesses that is actionable immediately upon signing, whether or not a person has capacity. It is recommended that individuals execute both a Health Care Proxy and MOLST form as the documents often address different circumstances. However, it is important to note that if an individual loses capacity, a health care agent may sign a MOLST form on behalf of the incapacitated person or even reverse decisions on an existing MOLST form in order to carry out what the agent believes is the principal’s known wishes for treatment.

MOLST versus DNR.

Do Not Resuscitate (DNR) directives remain valid in Massachusetts. MOLST forms also may be used to indicate a patient’s DNR directive. In cases of cardiac or respiratory arrest, if a MOLST form and DNR directive are both present, the order signed most recently will control. In all other cases, the MOLST form should be followed by health care providers.

Applicability of Massachusetts MOLST in other states.

MOLST programs (or programs equivalent to MOLST) exist in many, but not all U.S. states. A MOLST form in one state will be treated as evidence of a person’s preferences while he or she is in another state, but it is not binding in the other state. This means that if a person has a Massachusetts MOLST form, then all Massachusetts health providers must honor it. However, if the person needs medical treatment in another state, the Massachusetts MOLST form is only a record of his or her preferences, which may or may not be honored in the other state. If you frequently travel to another state, we recommend also completing a MOLST form in that state.

As estate planning attorneys, we may discuss MOLST forms but we do not assist clients with executing the forms. You should contact your physician to find out the best way to execute the forms. More information regarding the Massachusetts MOLST form, including Frequently Asked Questions, can be found at https://www.molst-ma.org/.

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