You may have heard about a new kind of health care directive in Kentucky, called a Medical Orders for Scope of Treatment (MOST) form. Following are some basic facts about this form.
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 instead of -- a DNR order. The MOST form may also provide other information about your wishes for end-of-life health care.
A doctor or other 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. The form is legally valid only if explained and signed by your doctor. (See Kentucky Statutes § 311.6225.) You or your legally appointed health care decisionmaker must also sign the MOST form.
If a member of the medical staff does not ask you whether you want to create a MOST form, you may ask for one.
In Kentucky, a MOST form is printed on brightly colored paper so it will 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 durable power of attorney for health care. Taken together, a living will and durable power of attorney for health care provide more information than a MOST form, including information about your health care agent and more detailed health care wishes.
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 a 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 declaration 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 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 preparing health care directives, see Kentucky's Living Will and Health Care Surrogate Designation: What You Need to Know.