Decisions about care at the end
of life are among the most personal
and deeply considered our patients
make. To help ensure those wishes
are followed, the North Carolina
Medical Society led efforts to create
a new form that allows patients to
clearly communicate their prefer¬
ences regarding such interventions
as CPR, artificial nutrition, hydra¬
tion and transfer to a hospital.
The form, called Medical Orders
for Scope of Treatment or MOST,
received statutory recognition in
2007 (NC Gen. Stat. § 90-21.17). Later that year, the De¬
partment of Health and Human Sendees adopted an official
MOST form.
The form enables patients to make informed choices about
end-of-life care protocols and to formalize them in a way that
authorizes health care providers to act in accordance with those
choices.
Legal instruments such as Living Wills and Health Care
Powers of Attorney already play a role in informing physicians
and other health care providers about the level and type of care
desired in situations when the patient no longer can make or
communicate decisions. The MOST form differs significantly
in that it alone functions as medical orders.
Since 1991, six states have used documents similar to the
MOST form and 10 other states are developing their own ver¬
sions. The movement towards such resources for patients and
their physicians is partially driven by Physician Orders for Life-
Sustaining Treatment or POLST, which advocates the right of
patients to set the terms of end-of-life care. For more informa¬
tion, visit www.polst.org.
Some parts of North Carolina have tested a version of the
MOST form for years. Buncombe County began preliminary
use of a MOST-like form with more than 200 residents of four
long term care facilities and providers from hospice and hospi¬
tal care. In Greenville, four other long term care facilities use
the same form as a tool to better communicate with patients
upon admission to Pitt County Memorial Hospital. The form
has received positive reviews in both pilot programs.
The state -sanctioned MOST form also has been well re¬
ceived. In fact, interest in it has been far broader than antici¬
pated.
The Medical Society’s Ethics and Judicial Affairs Commit¬
tee, which developed the MOST form, expected it to be used
mainly by patients with an advanced, chronic progressive ill¬
ness and life expectancy of less than one year. However, many
patients have used the MOST form to indicate their wishes well
in advance of the end-of-life situation originally envisioned.
The MOST form is completely voluntary, but patients or
their representatives may not use it until and unless he or she
participates in in-depth discussions about the choices available.
To be binding, the form must bear the signature of both the
physician or physician assistant or nurse practitioner, and the
Janette A. Rhyne, MD
In This Issue of the FORUM
Item Page
President’s Message
Medical Orders Jin- Scope of Treatment . 1
■Jane lie A. Rhyne, MD
Update on USMLE Step Attempt Limits . 2
Prevent Prescription Misuse . 2
Governor Names William A. Walker, MD,
Thomas R. Hill, MD, and Janice E. Huff, MD,
to NC Medical Board . 3
New Method for Selecting Board Members . 4
‘Nancy H. Hemphill, JD
Board Adopts Proposed Rules on New Physician Profile . 5
‘Thomas W Mansfield, JD
Item Page
NCMB Amends Administrative Rules . 7
Project Lazarus: Overdose Prevention and
Responsible Pain Management . 8
* Nabarun Dasgupta, MPH; Ercd Wells Brason, II;
Su Albert, MD, MPH; Kay Sanford, MSPH
NC Medical Board Releases 2007
Annual Board Action Report . 12
Board Actions: 1
1/2007
-
01/2008
. 14
(ihangc of Address . 24
NCMB Panel of Outside Reviewers Being Updated . 24
Board Calendar . 24
