MOLST advisory council agrees wording changes, keeps training and public outreach work moving

The MOLST Advisory Council, convened under the Department of Public Health, agreed at its May 2025 meeting to revise wording on the state MOLST (Medical Orders for Life-Sustaining Treatment) form and to continue developing training materials and limited public messaging, members said.

Council members said the changes aim to reduce confusion for clinicians and patients about choices on CPR, breathing interventions and treatment goals, while the training subcommittee will finish three slide decks — an overview, a provider deck and an EMS-focused deck — and continue discussing whether and how to make a short public-facing information item.

At the meeting, Barbara Jacobs, training subcommittee member, described the education work under way: "1 is for a slide deck for a general overview of MOLST that will be an introductory piece to the other pieces." Members agreed the subcommittee should keep developing materials for eligible providers (physicians, APRNs and physician assistants) and an EMS-specific deck; the EMS core education coordinator, Joel Demers, has been added to the mailing list and participating in the process.

The council debated specific wording on the form. Kathy (clinician) raised a clinical concern about the relation between CPR and breathing choices, saying participants should be able to indicate they do not want cardiopulmonary resuscitation but would accept particular breathing interventions: "If someone is DNR, they may not be DNI. And I just want people to have that option if they want intubation but not CPR." After discussion the group agreed to relabel the breathing item for clarity; one suggested formulation adopted during the discussion was "breathing compromise; not related to cardiopulmonary arrest." A council participant summarized that section as intended "for breathing compromises not associated with cardiopulmonary arrest."

Members also cleared a change to remove the phrase "allow natural death" adjacent to the "do not attempt CPR" choice, because several members said that phrasing could add an emotional layer and confuse patients. The council agreed to spell out "cardiopulmonary resuscitation" (with the acronym CPR appearing in parentheses) where that term appears on the form.

On the form's description of treatment goals, the advisory group revised the wording for selective treatment to read along the lines of: "Goal is to treat medical conditions with some limits as designated below." The group discussed alternative phrasings and agreed this version better signals that selective treatment means the patient and provider have placed at least one limit on interventions.

The council debated whether to require that clinicians specify the diagnosis supporting an "advanced chronic progressive frailty" or "end-stage serious life-limiting illness" label. After discussion members decided to keep the diagnostic lines on the form (a short blank for clinicians to record factors or context) so the rationale is available in the medical record while recognizing that the electronic medical record should carry fuller documentation.

On public outreach, participants weighed options ranging from a simple fact sheet or wallet-style card to a brief public service announcement. Dr. Rich Kamen said, "I think the idea of a PSA is lovely," but several members warned against producing many distinct slide decks for public audiences because of maintenance burdens and the wide variety of audiences the council would need to reach. Members suggested the council instead identify a short, shareable messaging element and rely on partner organizations (health systems, probate education programs, legal continuing-education platforms) to disseminate more in-depth materials.

Procedural notes and next steps: the council kept policies, procedures, training and FAQs as a standing package to be brought together to the commissioner for approval; the training subcommittee will continue meeting biweekly to finalize decks; and the form edits discussed at the meeting will be incorporated for a final review at the council's June meeting. The council did not propose any changes that require new legislation; as one member noted, the previous legislative session had already removed the witness-signature requirement from the form and the current edits are within the council's existing authority.

The meeting concluded with the council agreeing to complete a near-final form update and to continue the public outreach discussion and training work before the next meeting.