A MOST form — standing for medical orders for scope of treatment — 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 form when you’re chronically ill or near end-of-life, and major health care decisions are looming. Learn what they are and how they impact your rights.
What you should know
Ideally, the process to complete a MOST form 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. It shouldn’t be completed or signed by you, as the patient.
You can’t be made to have a MOST form to receive health care services.
“My mom 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.”
– Jorge, Vancouver, BC
There’s no law in BC that governs MOST forms. For this reason, they should be used as a guide only.
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 form, 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.
More on consent
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 you are not capable of making a health care decision for yourself, someone will have to make the decision for you.
If you've made a representation agreement, when making health care decisions for you, the law says your representative must (in this order):
Determine and comply with your current wishes, if it’s reasonable to do so.
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.
If your wishes are not known: act based on your known beliefs and values.
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.
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.
Talk to your doctor if your circumstances or wishes change.
Steps you can take
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.