MOLST Form Massachusetts: What It Is, Who Needs One, and How to Get It

A health care proxy tells your family who makes decisions. A MOLST form tells emergency responders exactly what to do. When EMS arrives at 2 a.m. and your family is too overwhelmed to communicate clearly, the MOLST — printed on a bright, recognizable form — gives paramedics immediate, legally binding medical orders without a phone call, a court hearing, or a guessing game.

MOLST stands for Medical Orders for Life-Sustaining Treatment. Massachusetts currently uses MOLST, though the state is transitioning to the national POLST (Portable Medical Orders for Life-Sustaining Treatment) framework, with the electronic ePOLST Registry launching in Spring 2027.

MOLST vs. Health Care Proxy vs. Personal Directive

These three documents serve different functions in Massachusetts, and each has a different legal character:

Health Care Proxy is a legal document that appoints your Health Care Agent under MGL Chapter 201D. It becomes active only after a physician certifies your incapacity in writing. It is not a medical order — it delegates decision-making authority.

Personal Directive (living will) is a non-statutory document that records your treatment preferences. Massachusetts does not legally bind physicians to follow it, but it carries significant evidentiary weight when your agent needs to demonstrate your wishes under the "substituted judgment" standard.

MOLST is an active medical order signed by both you (or your agent) and a clinician — a physician, nurse practitioner, or physician assistant. It is legally binding on all clinical providers, including EMS, hospitals, hospice programs, and nursing homes. It translates your wishes into immediate, actionable treatment directives.

You need all three. The proxy assigns authority, the personal directive documents preferences, and the MOLST converts those preferences into orders that first responders can follow without delay.

Who Should Have a MOLST

MOLST is not for healthy 35-year-olds. The Massachusetts Department of Public Health designed MOLST for people with serious illness or advanced frailty:

• Patients with a terminal diagnosis
• Residents of skilled nursing facilities or long-term care
• Patients in hospice or palliative care programs
• Elderly individuals with multiple chronic conditions
• Anyone whose clinical team has initiated a "serious illness conversation"

If you are generally healthy, a Health Care Proxy and Personal Directive are sufficient. MOLST becomes relevant when your medical situation means that CPR, intubation, or hospitalization decisions could arise at any moment.

What the MOLST Form Covers

The Massachusetts MOLST form addresses specific clinical scenarios:

• CPR: Whether to attempt resuscitation if your heart stops or you stop breathing
• Medical Interventions: Full treatment, selective treatment, or comfort-focused treatment
• Artificially Administered Nutrition: Whether to use feeding tubes, and under what circumstances
• Antibiotics: Full treatment, limited treatment, or comfort measures only

Each section requires a clinical discussion between the patient (or their Health Care Agent) and the signing clinician about the risks, benefits, and expected outcomes of each treatment option. MOLST is not a checkbox exercise — it documents a medical conversation.

How to Get a MOLST Signed

You cannot download a MOLST form and fill it out at your kitchen table. The process requires a clinical conversation:

1. Ask your physician, nurse practitioner, or physician assistant to initiate a MOLST discussion
2. Review your treatment preferences for each category on the form
3. The clinician completes the form based on your discussion
4. Both you (or your Health Care Agent) and the clinician sign the form
5. The signed form travels with you across all care settings

The form must be completed in English to be legally valid and actionable for EMS responders, even though the Department of Public Health has translated MOLST educational materials into nine languages including Spanish, Portuguese, Vietnamese, and Chinese.

MOLST vs. Comfort Care DNR

Massachusetts also has a standalone Comfort Care / Do Not Resuscitate (CC/DNR) order. The distinction matters:

A Comfort Care DNR addresses one decision only: withholding CPR (chest compressions, intubation, and cardioversion). It says nothing about antibiotics, feeding tubes, hospitalization, or any other treatment.

A MOLST is broader. It covers CPR plus multiple categories of life-sustaining treatment. A MOLST that specifies "Do Not Resuscitate" functionally includes the DNR order plus additional treatment directives.

Both forms are fully portable across all clinical settings. EMS personnel are trained to recognize and honor both. If both a MOLST and a CC/DNR exist, responders follow the most recently signed document.

The 2027 ePOLST Transition

Massachusetts is transitioning from paper MOLST forms to an electronic ePOLST Registry. Key changes:

• The statewide electronic registry launches in Spring 2027
• After the transition, new paper MOLST forms will no longer be created
• Existing paper MOLST and CC/DNR forms remain fully valid during the transition
• The ePOLST system will allow EMS responders to access your medical orders electronically in real time

This transition makes proper advance care planning even more important. Having your Health Care Proxy and Personal Directive in place now ensures your agent can work with your clinical team to establish ePOLST orders when the registry goes live.

The Massachusetts Advance Directive & Living Will Kit includes a MOLST/ePOLST reference guide that explains how to coordinate your proxy, personal directive, and clinical orders into a single integrated plan.

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