You may have heard about a new kind of health care directive in Alaska, 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 (often called Comfort One in Alaska), 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 instead of -- a DNR order. The MOST form may also provide other information about your wishes for end-of-life health care.
If you enter a participating medical facility or health care setting, a health care provider can help you create a MOST form. Currently, MOST forms are available in Alaska Pioneer Homes (state run assisted living homes); they may be available at some hospitals as well.
To be valid, a MOST form must be signed by a doctor, nurse practitioner, or other approved medical professional. You can change or cancel a MOST form 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 advance health care directive.
An advance directive can provide more information than a MOST form. It allows you to name a health care agent, give more detailed health care instructions, and state your preference for organ donation. Therefore, if you have a MOST form, you do not need a DNR order, but you should still complete an advance directive to provide a full set of wishes for your care.
For details about making an advance directive, see Alaska Living Wills and Advance Health Care Directives: What You Need to Know.
You need to consider a MOST only if you're facing a life-threatening medical condition. If you're healthy, you need only an advance directive 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 an advance directive 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 order. 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 traditional health care directives.
For more on Alaska estate planning issues, see our section on Alaska Estate Planning.