An Analysis of the New York State Medical Orders for Life Sustaining Treatment Initiative

Abstract

New York State’s Medical Orders for Life Sustaining Treatment (MOLST) was created to ensure compassionate end-of-life (EOL) medical care for patients in New York State (NYS) who have become incapacitated and lack decision making capacity. The pioneers of NYS’ MOLST Initiative found that end-of-life needs were not being adequately carried out according to patient’s wishes under the then available practices. MOLST was created in order to replace or at least supplement advance directives (AD), health care proxies (HCP), and standalone do-not-resuscitate (DNR) orders. MOLST’s aim was to provide a more complete array of medical orders at end-of life that could be carried out by Emergency Medical Services and in all healthcare facilities throughout the state. Similar to Oregon’s Physician Orders for Life Sustaining Treatment (POLST) Paradigm, MOLST was created by a coalition of diverse stakeholders to ensure community acceptance. Utilizing the methodologies and policy creation models advocated by Kingdon and Longest, I will analyze the creation of New York State’s MOLST Initiative and its current operational issues.