Educational Topics

Guest Editorial about MOST

Commentary by Tom Kaluzynski, MD, MemoryCare
One size fits MOST. That’s what the label said on a warm pair of abandoned mittens I found in the closet one cold morning this winter. After finishing my winter chore, I realized that the last few times I used the word MOST was as the acronym for North Carolina’s new document called Medical Orders for Scope of Treatment (i.e. MOST), which serves to outline one’s wishes to have or forgo life sustaining treatment. Recently, the NC General Assembly recognized the MOST form as a legal and portable physician order with the goal of promoting patient self-determined scope of care at the end of life (House Bill 634/Session Law 2007-502). This was not a last minute legislative add on to a hastily put together bill. The MOST form is the result of over four years of dedicated work by many individuals including members of the Buncombe and Henderson County medical communities. My hat goes off to those who put in the time and effort in making the MOST a form that can improve the way we can communicate end of life care goals in the advanced stages of a chronic progressive illness.

Pharmacological and technical advances in the field of medicine often bring up new scenarios that challenge us to ask, “What is the best thing to do or recommend when we are faced with some of the complex issues and emotions related to end-of-life care?” Is there a time in the course of an illness when keeping my mother at home with Palliative Care instead of repeatedly hospitalizing her would be a better approach? As my grandfather’s health care agent, how do I honor his wishes to ‘just let me go when my time comes?’ Each of us will face some of these challenges in deeply personal ways when we are called upon to be involved in such decisions for a family member or close friend.

The revision of the current NC statutes intentionally recognized that a document like the MOST form is a work in progress. Provisions were made to direct the NC Institute of Medicine to report back to the public and to the General Assembly (in 2013) on how, if at all, the changes in Session Law 2007-502 have had any meaningful effect on the goals of honoring and delivering the end of life care that an individual wants. Having a new form will not magically take away the doubt or uncertainty that comes with end of life care. It is important to remember that Advance Directives are tools to move us in the direction of our wishes, but as Dr. Anthony Perkins at the University of Texas Health Science Center in San Antonio recently wrote, they can, “presuppose more control over future care than is possible”. The more critical process is to promote discussion between patients, their health care agents and their health care providers so that when the difficult decisions come, as they most definitely will, the parties involved with have a better map to follow.

Author: Dr. Tom Kaluzynski is on staff at MemoryCare, a non-profit charitable organization serving individuals with memory disorders and their families.

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