MOLST advisory council to clarify revocation language after discussion on in-the-moment treatment changes

At an August meeting of the MOLST Advisory Council, members discussed whether the council's policies clearly distinguish between formally revoking a Medical Orders for Life-Sustaining Treatment form and a patient, while having capacity, requesting a different treatment at the time care is delivered. Barbara Cass, senior adviser to the commissioner of the Department of Public Health for long-term care, led the discussion about revising revocation language in the policies and procedures.

The difference, council members said, is procedural. Dante (staff member) described the current practice: "if you want to revoke a valid MOLST, you go back to an eligible provider ... that's how you can effectuate your revocation of a MOLST you have." He added that a patient in the moment can request different treatment even if the MOLST form indicates otherwise.

Kathy (committee member) asked whether a patient could override a medical order by declining to accept it, comparing the choice to not filling a prescription. "If I order a patient something in the hospital and the nurse goes to give it and they say, 'no. I'm not taking that,' I mean, that's the answer right there," said Dr. Sussman (clinician), underscoring that a patient with decision-making capacity may request different treatment.

Council members noted a separate question about whether a health care representative may, in the moment, change treatment goals or revoke a MOLST when the patient lacks capacity. Participants said the prevailing practice in other states is that a health care representative generally cannot effectuate an immediate revocation without documentation verifying their authority.

To address the ambiguity, staff recommended revising the revocation section of the policies and procedures and adding an FAQ and training content that explain the distinction between an in-the-moment patient choice and formal revocation. "I'll make sure that, you know, we respond to that concern by clarifying some of the language in the revocation section of the policies and procedures," Cass said. The revised language will be reviewed by DPH attorneys before finalization.

Council members also discussed operational steps for when a patient receives a treatment that differs from their MOLST: the group recommended a documented conversation in the clinical record and a follow-up clarification discussion before discharge, ideally within 24 hours, to confirm and, if needed, update the MOLST.

No formal motion or vote was taken on policy language changes during the meeting; members described this as staff direction to redraft the revocation wording and to circulate a clean version for review.

The council deferred approval of prior meeting minutes because a quorum was not present at the session, and the group adjourned after routine business.