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Everyday Legal Problems

Understand MOST forms (Medical Orders for Scope of Treatment)

Learn how a MOST form facilitates a conversation with your doctor about your wishes for care.

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“My mother Alexis entered residential care last year. She expressed a general preference to receive medical attention at the care home when possible. The doctor noted this in a MOST form. When Mom got pneumonia, legally, the care home still had to check in with her about whether she wanted to be treated at the hospital. The MOST couldn’t be used as a blanket directive for her care.”

– Jeorge, Vancouver

A MOST — Medical Orders for Scope of Treatment — form is a document used in hospitals, residential care and community care settings. It should be used to facilitate a conversation with your doctor about your values and wishes for care. You may encounter a MOST when you’re chronically ill or near end-of-life, and major health care decisions are looming.  

Ideally, the process should begin with an in-depth conversation between you and your doctor. If you have a representative under a representation agreement, they should be included, too. Together, you should focus on what kind of care is right for you. This should be an opportunity to discuss your values and wishes in the context of what's medically appropriate for your situation. Your doctor should complete and sign your MOST.

Here are some important things you should know about your legal rights in relation to MOSTS: 

Having a MOST is optional, not required

You can’t be made to have one to receive health care services.

MOST forms should be completed and signed by a doctor

They shouldn’t be completed or signed by you, as the patient.

There’s no law in BC that governs the creation and use of MOST forms

For this reason, they should be used as a guide only.

Legally, MOST forms do not substitute for consent

Remember, a MOST should simply be used as a tool to facilitate a conversation about your wishes for care, at a particular point in time. It should not be used to unilaterally dictate your future care decisions.

So what does this mean for you? Say a medical decision needs to be made. Your doctor or care provider must follow the law of medical consent. Even if you have a MOST, they must ask you directly for your consent to medical treatment. If you’re incapable of giving it, they need to get consent from your substitute decision-maker. Otherwise, they cannot treat you. What’s written in a MOST form should never override this consent process.

Under the law, consent applies only to the specific health care treatment that an adult has consented to. Generally speaking, consent must be obtained for every health care decision, as it arises. There’s an exception for emergencies.

If someone else needs to make decisions for you, a MOST may be helpful

If you are not capable of making a health care decision for yourself, someone will have to make the decision for you.

A representative

When making health care decisions for you, the law says your representative under a representation agreement must (in this order):

  1. Determine and comply with your current wishes, if it’s reasonable to do so.
  2. Comply with the wishes you expressed when you were capable. If you had a MOST conversation with your doctor when you were capable, what’s written in the MOST should represent “wishes you expressed when capable.” Legally, your representative must consider these wishes, along with other any other wishes or instructions you expressed when capable. For example, you may have written these in an advance care plan or spoken to your representative.
  3. If your wishes are not known: act based on your known beliefs and values.
  4. If your beliefs, values and wishes are not known: act in your best interests .

A temporary substitute decision-maker

A temporary substitute decision-maker is a person who will be temporarily appointed to make a specific health care decision for you. They’ll only be called on if you don’t have another authority in place that addresses the health care need. They may be called if you have a representative under a representation agreement who is not available.

When making a decision on your behalf, the decision-maker must consult with you, if possible. The law says they must also follow any wishes or instructions you expressed when you were capable. 

How does a MOST fit in here? If you had a MOST conversation with your doctor when you were capable, what’s written in the MOST should represent “wishes you expressed when capable.” The decision-maker should consider these wishes, along with other any other wishes or instructions. You may have expressed in an advance care plan or to them directly.

If your wishes aren’t known, the decision-maker must give or refuse consent based on your best interests. This includes considering your current wishes, and known beliefs and values. It also includes considering the risks and benefits of the proposed health care.

This page has more in-depth coverage of temporary substitute decision-makers.

In an emergency, a MOST may be helpful

The law says that a health care provider may not always need to get your consent to provide you with treatment. This applies in emergency situations, where they need to act swiftly to save your life or prevent serious damage. And it only applies where you’re not able to give direct consent, or your representative under a representation agreement isn’t available. 

However, a health care provider can’t provide you with emergency health care that’s contrary to wishes you expressed when you were capable. This would include wishes expressed in a MOST.

Your MOST can be changed

Talk to your doctor if your circumstances or wishes change.

Know your legal rights

We’ve outlined how MOST forms should ideally be used. This may not always be in line with how the form is used by hospitals or other care providers. It’s a good idea to get on the same page as your care providers. If a MOST is created for you, ask them to clearly explain to you how it will be used. You may want to confirm your understanding that it won’t be used as a blanket directive for care. This means that it can’t override the process of seeking consent under the law.

Refer to your local health authority for more information on the use of MOSTs in your area. There may be differences in when and how each form is used, depending on where you receive your care.

Why You Should Plan for Your Future

Learn your options for planning for your future financial, legal, health care, and personal care needs. 

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“Last year, I found my wife Paige lying on the kitchen floor. She’d had a stroke. It was so sudden. Paige was smart with our money. A lot of it was tied up in investments — in her name. I was shocked when the bank said I didn’t have authority to access her money. I’m her wife — isn’t that enough? After all, I need the money to care for her. I wish we’d thought to plan ahead.”

– Ramona, Oliver

No one wants to think about illness and death. But the truth is, none of us know when illness or accident or cognitive impairment will strike. One day, you may be in a position where you’re unable to make decisions for yourself. In that case, someone will need to help you make decisions, or make decisions for you. Big ones — like where you’ll live. Or small ones — like making sure the heat stays on. It’s wise to consider in advance who you’d like to make those kinds of decisions for you. 

Getting your future care settled will set you up to live well — from the day you really need help until the end. Having a plan in place gives those close to you peace of mind. Planning is about living — and dying — on your own terms. 

Plan to have a say in your future

In British Columbia, a patchwork of laws spell out who can make financial, legal, health care, and personal care decisions for you. Imagine a situation where you’ve become incapable of making these types of decisions independently. In these circumstances, the various planning laws fall into two groups:

1. The default choice. What the law says will happen if you haven’t planned.

2. The plan you choose for yourself. A number of legal options let you override that default choice and have a say in the decision-making. You can plan ahead so that you have a say in who can make decisions for you if you ever can’t make them yourself. 

Learn six important reasons why you need to plan for your future.

1. Planning is for everyone

“When we first had ‘the talk’ about end-of-life care, Mom wasn’t wild about singling out specific family members to take the lead. Our family is used to making important decisions as a group. But Mom’s lawyer reminded her of an important point. If something happened to her, only one person would, by default, be asked to make medical decisions for her anyway. Mom’s lawyer tailored the agreement to reflect Mom’s preferences. In her representation agreement, Mom appointed four family members to make decisions by majority rules. When she got really sick, everyone knew what to do.”

– Akal, Chilliwack

The way people handle illness, make decisions, or even who they consider to be "family" may differ depending on their culture, religion and other aspects of their identity. For example, in British Columbia, the law emphasizes the right of the individual to make decisions about their own care. This may not be how things are done in your family.

But the reality is these laws apply to you. So it’s important to learn about them, whatever your background. Learning about your legal options can empower you to achieve what you want.

Legal documents can be tailored to fit your preferences and circumstances. You might just want one person to make all of your future decisions, if ever needed. Or you can choose two (or more) people. And you get to decide whether they must make decisions together, and how. For an example of how this can play out, see our page on enhanced representation agreements.

2. Planning puts you in a position to make informed choices

When people think hard about their goals and values, they tend to make better choices. 

Planning involves learning about your legal options and figuring out how they apply to your life. You can take this opportunity to:

  • take a closer look at your financial situation,
  • review your medical history, and understand your health care options,  
  • explore your values, wishes and beliefs, and
  • think about what you want your future to look like.

You and your chosen decision-maker will benefit from this process. You’ll both make more informed decisions in moments of crisis. And these decisions are more likely to line up with your values and wishes. 

3. Putting plans in place can ease the burden on those close to you, financially and emotionally

“While we were vacationing in Hawaii, my partner Abby started complaining about sore joints. We thought it must have been from all the hiking. But it didn’t go away. Turns out she had bone cancer. I can’t believe how fast it happened. One day she was here, the next she was not. After she died, I felt so guilty. Should I have dragged her to all of those doctors appointments? Would she have preferred to spend her last weeks at home with me and the kids? It keeps me up at night.”

– Elliott, Burnaby

Planning in advance also helps to reduce the burden of everyday caregiving. For example, your attorney (under a power of attorney) can step in seamlessly to deal with your finances, as needed. Your day-to-day bills, rent or mortgage payments, and medical expenses can be covered without delay. 

Research shows that planning for your health care results in better outcomes for family members and caregivers. Planning reduces the burden of decision-making, relieves anxiety and depressive symptoms, and makes people more satisfied with the care provided.

4. Planning gives you control over what happens to your money

Planning doesn’t just give you control over what happens to your body. It also helps you control what happens to your money and assets. 

This is particularly important if you want to protect your assets because:

  • you have dependents who need support, but the assets to support them are under your name alone,
  • your loved ones need access to your money to provide you with good care, or
  • you’re the joint owner of a certain asset (such as a house), and a sale or refinancing isn’t possible without your signature.

5. If you don’t make plans, the court may become involved

No one has the automatic authority to make legal, financial, or even personal care decisions for you if you become incapable. As a last resort, a family member or friend may need to apply to court to get the authority to make decisions for you. To do this, they’ll need to ask the court to appoint them as your committee. A committee has the same rights and powers over your affairs as you would if you were capable.

There are two types of committees:

  • A committee of person becomes responsible for making decisions about an adult’s health and personal matters.
  • A committee of estate becomes responsible for making decisions about an adult’s financial and legal affairs.

“Our daughter Helene was in a boating accident… she hasn’t been the same since. Her rehab expenses are skyrocketing. We want to sell her investment property to pay for her care expenses. We’ve been told that because she didn’t plan in advance, our only option is for one of us to apply to court to become her committee of estate. I can’t believe we have to jump through all of these legal hoops just to help our child.”

– Alphonse, Squamish

Going to court is rarely a desirable Plan A. It’s expensive and time-consuming and can cause unnecessary stress for family and others close to you. It can take months or even years for applications to be heard in court. This can delay access to money needed for your care and degrade your quality of life. 

Usually, a family member or friend applies to become committee. But there’s no guarantee the court will appoint them. Before appointing a committee, the court must declare you incapable. This declaration strips you of your decision-making rights over your body and property. 

The Public Guardian and Trustee can be appointed as committee

This may happen, for example, when there’s family conflict or no one steps forward to apply. The Public Guardian and Trustee is a public body that protects the interests of British Columbians who lack legal capacity to protect their own interests.

If it appears that an adult needs help, a provincial health authority may conduct a medical and functional assessment. If the adult is found to be incapable, the health authority will issue a certificate of incapability. The Public Guardian and Trustee can automatically be appointed after this certificate is issued. 

6. If you don’t plan and you need medical treatment, someone else will be asked to give consent for you

If you’re incapable of consenting to a health care treatment, someone else needs to make the decision for you. There’s a hierarchy of authority that a health care provider must follow if a decision needs to be made and you’re not able to make it. 

At the bottom of the hierarchy is a temporary substitute decision-maker

This person will be temporarily appointed to make a specific health care decision for you. They’ll only be called on if you don’t have another authority in place that addresses the specific health care need. Unlike other authorities which you can choose in advance, a temporary substitute decision-maker is not someone chosen by you — it may be someone you never would have wanted to make a decision about your health for you.

To choose a temporary substitute decision-maker, your health care provider must choose someone from a ranked list, as set out under the law. See our page on temporary substitute decision-makers to learn more about who might be chosen and what they’ll be asked to do.

Start planning

Planning begins with imagining — truly imagining — yourself reduced to incapacity. Who do you ideally see in this picture, making important decisions for you? How involved do you want them to be? Once you’re clear on your wishes, it’s time to make a more concrete plan.

Explain to your family and friends exactly what you’d like to see unfold. A good place to start is to think about how and by whom, you would want decisions to be made if you ever become unable to make decisions for yourself. Then learn about the planning options that are available in British Columbia and seek advice about how they might be used to achieve what you want

Learn more about your options for planning for your future financial and legal affairs, as well as your health care and personal care planning options.

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