Connecticut Health Care Representative and MOLST Form: What Families Need to Know

When a Connecticut resident becomes seriously ill and can no longer speak for themselves, two documents can control what medical treatment they receive: a health care representative designation and a MOLST form. Most families have heard of advance directives or living wills — but those documents have significant limitations in Connecticut that make the MOLST and health care representative appointment substantially more useful in a medical crisis.

Understanding the difference before a crisis is essential. Once someone loses capacity, these documents cannot be created or amended.

What a Health Care Representative Does

Connecticut law allows individuals to formally appoint a health care representative — a trusted person authorized to make comprehensive medical decisions on their behalf when they lack the capacity to communicate those decisions themselves.

This is different from a general healthcare proxy or a living will. A Connecticut health care representative has broad authority to:

• Consent to or refuse any medical treatment, procedure, or surgery
• Make decisions about life-sustaining treatment (ventilators, feeding tubes, resuscitation)
• Access the patient's medical records
• Speak with all healthcare providers
• Make decisions about care settings, including transfers between facilities

The representative's authority activates only when the patient is incapacitated — unable to understand and communicate their own healthcare decisions. When the patient recovers capacity, the representative's decision-making authority is suspended.

To appoint a health care representative in Connecticut, the designation is included in an advance health care directive document — the state's formal mechanism for combining a living will and representative appointment. The document should specify the representative's name, the alternate representative if the first is unavailable, and the scope of authority granted.

The Living Will Limitation

A traditional living will (or advance directive) is a written statement of your medical wishes — what treatment you do or do not want under specific circumstances, typically involving terminal illness or permanent loss of consciousness.

The critical limitation of a Connecticut living will: it only takes effect when the patient has a terminal illness or is in a permanent state of unconsciousness. It does not cover the full range of medical crises. A serious stroke, a severe injury, advanced dementia in an intermediate stage, or an acute cardiac event may not trigger a living will if the treating physician determines the patient's condition does not technically qualify.

This gap is precisely why the MOLST form was developed.

What the MOLST Form Is

MOLST stands for Medical Orders for Life-Sustaining Treatment. Unlike a living will, a MOLST is not a statement of wishes — it is an actual medical order that becomes part of the patient's medical chart and travels with them across all care settings.

A MOLST order covers specific, immediate medical decisions:

• Whether to attempt cardiopulmonary resuscitation (CPR) if the patient's heart stops
• Whether to use mechanical ventilation or other forms of artificial breathing support
• Whether to use artificial nutrition and hydration
• Whether to transfer to a hospital or treat in the current setting (home, nursing facility)

Because it is a medical order — not just an expression of wishes — a MOLST takes effect immediately and applies in any care setting: at home, in a nursing facility, in the emergency room, or in the hospital. Emergency medical personnel can honor a MOLST without calling a physician for authorization, which is critical in an emergency where minutes matter.

Who Can Sign a Connecticut MOLST

This is where Connecticut's MOLST rules create a barrier that families often discover too late.

A Connecticut MOLST must be signed by a physician, Advanced Practice Registered Nurse (APRN), or physician assistant who has completed specific Department of Public Health (DPH)-approved MOLST training. This is not a standard document that a general practitioner can dash off — the signing clinician must have completed the training program and be familiar with the specific protocols.

What this means practically: you cannot create a MOLST at home and bring it to the hospital for a physician to sign casually. The conversation about a MOLST must happen with a clinician who is already trained in the process, typically a palliative care specialist, a geriatrician, or a physician familiar with end-of-life planning.

The appropriate time to pursue a MOLST is when a person is diagnosed with a serious illness, progressive condition (such as advanced heart failure, COPD, or cancer), or when they begin receiving care in a long-term care or hospice setting. A MOLST is not typically appropriate for healthy individuals with no serious medical conditions — the living will and health care representative appointment cover those situations.

How MOLST, Living Will, and Health Care Representative Work Together

These three mechanisms are not mutually exclusive — they work as a layered system:

A comprehensive approach for a seriously ill person includes all three: a living will that expresses general values and wishes, a health care representative who has specific authority to make decisions within those values, and a MOLST that converts the most critical decisions into standing medical orders.

The Intersection with Estate Administration

Healthcare directives and powers of attorney are pre-death planning mechanisms. Once a person dies, these documents have no legal effect.

What does carry forward into estate administration is everything the deceased left behind — assets, debts, real estate, and the question of whether a formal probate proceeding is required. If your family is dealing with a Connecticut estate after a loved one's death, the focus shifts entirely to the Probate Court system.

The Connecticut Probate Process Guide covers the full post-death administration process — determining whether the estate qualifies for simplified small estate procedure, navigating the 54-district court system, meeting the 6-month CT-706 NT deadline, and handling real estate transfers. The healthcare planning documents were for before; the probate guide is for after.

If you are in the planning phase and want to get both sides right, addressing the health care representative designation and MOLST alongside the power of attorney and will is the most complete approach to protecting a family from unnecessary legal and medical complexity.

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