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General News · 3rd June 2023
Margaret Verschuur
Adults with an advancing illness, increasing frailty, or a chronic condition that is life limiting or life threatening may say they’d like ‘no heroic measures’. What does this mean?

We always have the right to consent to or refuse health care treatment. However, a situation may arise when we are unable to speak for ourselves. Advance Care Planning is about talking with your health care providers, family and loved ones about your wishes and instructions for future health care treatment. Your health care team will ask you about your goals of care, and treatment options. Talking with them will help you to better understand your health condition, possible treatment choices, and options for care that are best for you. From these advance care planning conversations, your doctor or nurse practitioner will write a MOST.

A Medical Order for Scope of Treatment (MOST) identifies six designations for levels of treatment that provide direction on adult resuscitation status, critical care and medical interventions. Although an option for all adults, this is especially important for those with specific health issues.

MOST has replaced “No CPR" in acute and long-term care. It is valid in all care settings, including community care, and honoured by the BC Ambulance Service. 

No Cardiopulmonary Resuscitation (No CPR), also commonly referred to as a DNR, allows capable adults to request that no cardiopulmonary resuscitation be started on their behalf. This form would be completed after discussions with the doctor or nurse practitioner. It instructs people, such as first responders, paramedics and health care providers, not to start CPR on the person’s behalf whether they are at home, in the community or in a residential care facility. Emergency responders will look for the form on the fridge. Performing CPR is often damaging for an elderly or frail person, and rarely helpful. 

Notification of Expected Death in the Home (EDITH) is filled out by your health practitioner when a death is expected in the home within a few months. When death occurs of the expected cause, there is no requirement for a health care provider to pronounce death. Caregivers would let the health practitioner know the date and time the death occurred.

A Representation Agreement Section 9 (RA9) authorizes someone to speak on your behalf for health and personal care matters. The RA9 covers decisions about minor and major health care, refusing life support, as well as living arrangements and lifestyle preferences. This is a legally enforceable document which all adults, not just those with current health issues, would be wise to have in place. The RA9 is the topic of another article. 

As we plan ahead for future health care decisions, in the event we cannot communicate our wishes, having a Representation Agreement appoints someone to speak on our behalf. MOST documents the level of medical intervention we’d like. No CPR informs health care providers not to start CPR on our behalf. An EDITH form should be in place if there is an expected death in the home. By using the document appropriate for your situation, you can define what is meant by ‘heroic measures’.