You might have heard about a new kind of health care directive in D.C., 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 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 instead of -- a DNR order. The MOST form may also provide other information about your wishes for end-of-life health care.
In February 2016, the District of Columbia passed a law called the Health Care Decisions Act of 2015, authorizing the D.C. Department of Health to develop and publish a MOST form. The form should be available by the end of November 2016.
When the form becomes available, an authorized health care professional can help you create one at the time you enter a medical facility or health care setting -- such as a hospital, nursing home, or hospice care in a facility or at home. To be legally valid, either your attending physician or advance practice nurse must explain the form to you and sign it. You or your legally appointed health care decisionmaker must sign the form as well.In addition to the health care professional's signature, you or your legally appointed health care decisionmaker must sign the MOST form.
The MOST form will be printed on bright paper so it will easily stand out in your medical records. The form will travel with you if you move from one health care setting to another. You may 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 durable power of attorney for health care.
Taken together, a living will and health care power of attorney provide more information than a MOST form, including details about your health care agent and more complete health care instructions. Therefore, if you have a MOST form, you do not need a DNR order, but you should still complete a living will and health care power of attorney to provide a full set of wishes about your care.
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 durable power of attorney for health care 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 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 details about making an health care directives, see D.C. Living Wills and Medical Durable Powers of Attorney: What You Need to Know.
We will update this article as more information is made available about the District of Columbia MOST form. If you have questions about the form, ask your doctor or contact the D.C. Department of Health.