You may have heard about a new kind of health care directive in North Carolina, called a Medical Orders for Scope of Treatment (MOST) form. Here, we discuss what a MOST form is and when you might need one.
A MOST form is a doctor’s order that helps you keep control over medical care at the end of life. Like a Do Not Resuscitate (DNR) order, the form tells emergency medical personnel and other health care providers whether or not to administer cardiopulmonary resuscitation (CPR) in the event of a medical emergency. A MOST form may be used in addition to -- or, sometimes, instead of -- a DNR order. The MOST form may also provide other information about your wishes for end-of-life health care, as explained below.
A health care professional can help you create a MOST form if you enter a medical facility or health care setting -- such as a hospital, nursing home, or hospice care in a facility or at home. If a member of the medical staff does not ask you whether you want to create a MOST form, you may ask for one.
To be legally valid, a MOST form must be signed by:
In North Carolina, a MOST form is usually printed on bright pink paper so it will easily stand out in your medical records. The form travels with you if you move from one health care setting to another. You can change it or cancel it at any time.
A MOST form differs from a DNR order in one important way: A MOST form also includes directions about life-sustaining measures in addition to CPR, such as intubation, antibiotic use, and feeding tubes. The MOST form helps medical providers understand your wishes at a glance, but it is not a substitute for a properly prepared living will and health care power of attorney.
Taken together, a living will and health care power of attorney can provide more information than a MOST form, including details about your health care agent, more complete health care wishes, and your preference for organ donation.
You need to consider a MOST only if you're facing a life-threatening medical condition. If you're healthy, you need only a living will and health care power of attorney to provide a full set of wishes for your treatment in the event of an unexpected accident or medical crisis.
On the other hand, a patient diagnosed with a terminal illness or frailty that requires care in a medical setting -- or ongoing care at home -- may need a MOST in addition to traditional health care directives. That’s because a living will and medical power of attorney may not be enough to prevent medical personnel from resuscitating a patient in an emergency. For that, it's important to have a medical order such as a MOST or DNR form. If you feel strongly that you don’t want emergency measures at the end of life -- or if you’re caring for someone who feels that way -- find out about making a MOST in addition to an advance health care directive.
For more information about making health care directives, see North Carolina Living Wills and Health Care Powers of Attorney: What You Need to Know.
For general information about how to document your health care wishes, see the Living Wills & Medical Powers of Attorney section of Nolo.com.
For more on North Carolina estate planning issues, see our section on North Carolina Estate Planning.