Completion of the MOLST begins with a conversation or a series of conversations between the patient (or the patient’s health care agent or surrogate) and a qualified, trained medical professional. These conversations should define the patient’s goals for care, review possible treatment options and the entire MOLST form, and ensure shared, informed medical decision-making. Although the conversation(s) about goals and treatment options may be initiated by any qualified and trained medical professional, a licensed physician, nurse practitioner, or physician assistant must always, at a minimum: (i) confer with the patient and/or the patient’s health care agent or surrogate about the patient’s diagnosis, prognosis, goals for care, treatment preferences, and consent by the appropriate decision-maker, and (ii) sign the orders derived from that discussion.
The physician/nurse practitioner/physician assistant must also review the form from time to time, and also if the patient moves from one location to another to receive care; or if the patient has a major change in health status (for better or worse); or if the patient or other decision-maker changes their mind about treatment.
Unfortunately, not all medical providers are willing to sign a MOLST, and some that are willing will usually only sign it if you are expected to die within a year or are in a nursing home. However, there is no law restricting MOLST forms to those criteria, and if you qualify, it may be valuable to ask your medical provider to complete a MOLST.