MOST – Medical Orders for Scope of Treatment

In addition to an advance directive, your loved one should talk with his or her health care provider about a Medical Orders for Scope of Treatment (MOST). This is literally an order from a doctor detailing the life support treatments your relative wishes to receive or not receive. Think of it like a prescription.

Across all settings
In the chain of command of the medical system, a MOST provides the instructions for all the other people on the health care team. No matter where your loved one is—at the hospital, in a skilled nursing facility, or at home with EMTs (emergency medical techs) from a 911 call—the MOST makes it clear what the staff is supposed to do, or not do, to be true to your loved one’s wishes.

Shared decision-making tool
Although the order is from the doctor, the MOST is designed to be a tool to assist in a conversation with your relative. The doctor can describe the different life support measures, their pros and cons. It is your loved one who makes the decision about which ones feel right for his or her values and desired quality of life.

Your loved one stays in control
With a MOST, your relative’s choices are what matters. He or she has set the course ahead of time so care unfolds according to his or her wishes, even if your loved one is unconscious or unable to speak when the time comes.

Get help with the conversation
If you would like to have someone to talk to about the MOST, give us a call at 336-285-9107. We are well-versed in this document and have people dedicated to answering your questions!


• Where should we store the MOST?

The doctor will keep it in his or her medical records. If the doctor’s office is linked up with the local hospital’s electronic record system, they will have it also. You should ask for a copy. Keep it on the refrigerator at your loved one’s home. Emergency medical techs (the people who respond to 911 calls) are trained to look there for important documents and instructions like the MOST. If you are driving to the hospital yourselves, without an ambulance, try to remember to bring the MOST with you. It simply helps to keep it with your relative at all times.


• How is a MOST different from an advance directive?

Many people wonder whether they need to complete a MOST AND an advance directive. The answer is YES. An advance directive names your loved one’s preferred decision maker. It also gives a general sense of preferred life support measures. Advance directives can come in several formats and they are not always the same. They often include room for more descriptions, like a conversation. In an emergency, medical staff need short, easy to find, quick instructions. A MOST provides that and makes sure that each of the possible life support measures has been addressed.


• Can a MOST be changed?

Yes. As long as your loved one is conscious and can talk to the doctor about his or her wishes, a new MOST can be created. It will be put in the medical records and your relative will be given a new form to replace the old one.


• Where can we learn more about life support measures?

Check out our article about Health Care Planning. There is a section about life support measures. For each intervention, it will give you some facts about success rates, long-term consequences, risks and benefits. Reading this before meeting with the doctor can help your loved one prepare questions for the conversation.


• Should everyone have a MOST?

No. Unlike an advance directive, a MOST is just for people who are seriously ill.  If your loved one does not want to have this discussion, a MOST is not required. Having a MOST simply adds greater certainty that all desired medical treatments, and only the desired medical treatments, will be employed.

Want to talk?
If you or your loved one have questions about the MOST, or about advance directives, give us a call at 336-285-9107. Our knowledgeable team can give you and your loved one the time that is needed to fully understand and work through the options.

What can you do to help your loved one make an appointment to create a MOST with his or her health care provider?
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