MOLST Form New York: What It Is and When Your Parent Needs One

Your parent's doctor asks whether you want to discuss a MOLST. You've heard of a living will and a health care proxy, but this is a different document entirely — and it carries more immediate weight than either of those.

MOLST stands for Medical Orders for Life-Sustaining Treatment. Unlike a living will (which states your parent's preferences) or a health care proxy (which names someone to make decisions), a MOLST is a set of physician orders that medical staff must follow. It's a bright-pink form in New York, and when paramedics see it, they act on it — no interpretation required.

What the MOLST Form Covers

The New York MOLST form addresses specific clinical scenarios:

• Resuscitation status. Whether to attempt CPR if the patient's heart stops or they stop breathing. A "Do Not Resuscitate" (DNR) order goes here.
• Intubation and mechanical ventilation. Whether to place the patient on a breathing machine.
• Transfer to a hospital. Whether the patient should be transported to an emergency department or treated in place (relevant for nursing home and hospice residents).
• Artificial nutrition and hydration. Whether to use a feeding tube or IV fluids if the patient can no longer eat or drink.
• Antibiotics. Whether to treat infections aggressively, use limited antibiotics for comfort, or withhold them entirely.

Each section has checkboxes. The physician marks the appropriate options based on a conversation with the patient (or the patient's health care agent if the patient lacks capacity). Once signed by the physician, these become standing medical orders.

Who Can Request and Sign a MOLST

The MOLST is a collaborative document. It requires both a medical professional's signature and the informed consent of the patient or their legal representative:

• If your parent has capacity, they discuss treatment preferences with their doctor and the doctor completes the form based on that conversation.
• If your parent lacks capacity, the health care agent (appointed through a health care proxy) has the authority to make these decisions on the parent's behalf.
• If no health care proxy exists, New York's Family Health Care Decisions Act establishes a priority list of family members who can consent — but this surrogate authority has narrower scope than an appointed agent.

The MOLST must be signed by a physician, nurse practitioner, or physician assistant. A family member cannot complete the form on their own.

MOLST vs. Living Will vs. Health Care Proxy

These three documents serve different functions and operate at different levels:

A living will is a personal statement of your parent's treatment preferences. New York recognizes living wills under common law (the Matter of O'Connor standard), but they are not physician orders. A living will guides decision-makers; it doesn't bind first responders.

A health care proxy names the person who will make medical decisions when your parent cannot. It grants authority to a person but doesn't specify what decisions that person should make.

A MOLST converts treatment preferences into physician orders. Emergency medical technicians, nursing home staff, and hospital personnel follow MOLST orders the same way they follow any other physician order. When a paramedic arrives at your parent's home and finds a MOLST form indicating DNR, they honor it without calling the hospital for confirmation.

The practical hierarchy: the health care proxy names who decides, the living will records what the patient wanted, and the MOLST translates those wishes into orders that medical staff execute immediately.

When a MOLST Is Appropriate

A MOLST is not a routine planning document for healthy adults. It's designed for people with serious medical conditions where treatment decisions might need to be made urgently:

• A parent with advanced dementia living in a nursing facility.
• A parent with a terminal illness who has decided on comfort-focused care.
• A parent with a chronic condition (advanced heart failure, late-stage COPD) where hospitalization and resuscitation decisions are clinically relevant.
• Any situation where your parent has been told they have a life expectancy of roughly one year or less.

For a parent in good health who simply wants to plan ahead, a health care proxy and living will are the right tools. The MOLST comes later, when the clinical picture warrants specific standing orders.

Updating or Revoking a MOLST

A MOLST stays in effect until it's revoked or replaced. If your parent's condition or preferences change, the form should be updated through a new conversation with the treating physician. A patient with capacity can revoke a MOLST at any time by telling their doctor.

If the health care agent believes the existing MOLST no longer reflects the patient's wishes (for example, the patient previously wanted full treatment but has since entered hospice), the agent can request a new MOLST conversation with the attending physician.

The form travels with the patient. If your parent transfers from a nursing home to a hospital, the MOLST goes with them. If they return home from a hospital, the MOLST should be posted visibly — many families tape it to the refrigerator, which is where paramedics are trained to look.

Coordinating a MOLST alongside a health care proxy, living will, and financial power of attorney is one of the sequences covered in the New York Power of Attorney & Guardianship Kit, which walks through when each document is needed and how they work together.

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