Medical Orders for Scope of Treatment
The Medical Orders for Scope of Treatment (MOST) form is an important healthcare planning tool used within Island Health and across many healthcare settings in British Columbia. Its purpose is to ensure that a person’s healthcare wishes are clearly understood and respected, especially during medical emergencies or situations in which they may no longer be able to communicate their preferences.
Unlike a general advance directive, the MOST form is a medical order completed by a physician or nurse practitioner after a conversation about a person’s values, goals, and preferred level of care. The form outlines six different levels of treatment, ranging from comfort care to intensive critical care, including decisions about CPR, intubation, and whether a person wishes to remain comfortable in their long-term care facility rather than be transferred to a hospital.
A MOST form is usually completed by the “Most Responsible Practitioner” — typically a doctor or nurse practitioner — in consultation with the patient. If a patient cannot make decisions independently, discussions involve a Substitute Decision Maker, such as a spouse, adult child, or legally appointed representative. The process is meant to encourage meaningful conversations about quality of life, prognosis, and various medical interventions. The form should be reviewed periodically, especially if a person’s health condition or wishes change.
MOST is especially useful for adults with chronic illnesses, frailty, or life-limiting conditions. It is commonly used — and often required — in hospitals, long-term care homes, assisted living settings, and community healthcare. In emergencies, paramedics and hospital staff can quickly refer to the MOST form to understand the patient’s desired scope of treatment. This helps avoid unwanted or overly aggressive interventions while ensuring appropriate care is delivered promptly.
For an older adult living independently at home, the most immediate question may be: If my heart stops beating or I stop breathing, do I want paramedics to perform CPR? While CPR can save lives, it is often less effective for frail or elderly people, particularly those with underlying health conditions, and it can also cause harm. A No CPR form, completed by a doctor or nurse practitioner at the request of an individual, remains a clear and effective document. Paramedics are instructed to look on the front of the fridge for important healthcare documents.
While a No CPR form addresses a single healthcare intervention, the MOST form is broader and more comprehensive. One of its key benefits is improved communication among patients, families, and healthcare providers. Ultimately, the MOST form is an Advance Care Planning tool that supports patient-centred care by helping healthcare teams provide treatment that respects personal values, dignity, and quality of life.