MOST Form BC: Medical Orders for Scope of Treatment and DNR, Explained

Somewhere in your parent’s hospital chart — or clipped to the fridge at home on a distinctive green sheet — there may be a one-page form marked with letters like M3 or C1. That’s a MOST form: Medical Orders for Scope of Treatment. It’s one of the most important documents in BC end-of-life care, and one of the most misunderstood, because it looks like a legal document but isn’t one.

What a MOST Form Actually Is

A MOST form is a medical order signed by a physician or nurse practitioner, used across BC’s health authorities (Vancouver Coastal, Fraser, Island, Interior, Northern) to record a patient’s current goals of care as actionable clinical instructions. It translates a conversation about values into a code the entire medical system can read at 3 a.m.

The levels, roughly:

• M1 — Supportive care and symptom management only; comfort measures, natural death, no hospital transfer for life-prolonging treatment
• M2 — Medical treatments in current location, no transfer to acute care
• M3 — Medical treatment including hospital transfer, but no critical care (no ICU, no intubation)
• C1 — Critical care including intubation, but no CPR if the heart stops
• C2 — Full interventions including CPR

The patient (or their substitute decision-maker) discusses the options; the clinician signs the order; it enters the provincial electronic record. In care homes, review happens at the first care conference and at least every 12 months.

What a MOST Form Is Not

This is the part that catches families off guard: a MOST form is not consent, and it is not a legal document.

It wasn’t signed by the patient — it was signed by the doctor. When an actual treatment decision must be made for an incapable patient, clinicians still need consent from a legally authorized person: a representative under a representation agreement, or a Temporary Substitute Decision Maker from the statutory family list. The MOST form guides what the team proposes; it doesn’t replace the legal machinery.

It also isn’t automatically permanent. It’s a snapshot of current goals — it should be revisited after any significant health change, on hospital admission, and at least annually.

MOST vs Advance Directive: Who Wins?

An Advance Directive is the opposite kind of document: a legal instrument signed by you while capable, giving or refusing consent to specific treatments. It binds providers directly — including paramedics, who under the Emergency Health Services Act cannot perform emergency procedures they have reasonable grounds to believe you’ve refused in a valid directive.

So what happens when they conflict — say, a MOST form at C2 (full code) and a newer, dated Advance Directive refusing CPR? The dated Advance Directive legally prevails. Your written legal instruction outranks a clinical order. This is why keeping both current and consistent matters: a stale directive or a stale MOST form creates exactly the bedside confusion both documents exist to prevent.

Where a DNR Fits

People still ask for a “DNR form” — a Do Not Resuscitate order. In modern BC practice, that function is largely absorbed into the MOST system: a C1 or M-level designation accomplishes what a standalone DNR order once did, with more nuance about everything short of cardiac arrest. You may also encounter No CPR documentation from BC Emergency Health Services, which paramedics honour on scene.

Key points about DNR-type orders in BC:

• They are medical orders, signed by a clinician — you can’t self-issue one
• An Advance Directive refusal of CPR achieves a similar legal effect and binds responders, but it works best alongside a matching MOST designation, not instead of one
• Wristbands, fridge magnets, and photocopied notes have no legal force on their own — paramedics need the recognized form or a valid directive in hand

Getting the Paperwork to Agree

The strongest setup for a BC senior or anyone with a life-limiting condition:

1. Advance Directive stating precise refusals (e.g., CPR, ventilation) with clinically usable wording
2. Section 9 Representation Agreement so a named person can consent to what the directive doesn’t cover
3. MOST form completed with the family doctor, coded to match the directive
4. The physical MOST “greensleeve” kept visible at home, and the directive registered with Nidus for hospital access

When all four tell the same story, the system works smoothly. When they contradict each other, families get a 2 a.m. phone call instead.

The British Columbia Advance Directive & Living Will Kit includes a MOST conversation guide — the questions to bring to your doctor and how each answer maps to an M or C designation — alongside the legal documents, so the clinical and legal sides of your plan finally match.

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