Advance Care Planning and the MOST Form in British Columbia

Advance Care Planning Is Not One Document

Families in British Columbia often think advance care planning means signing a single form and filing it away. It doesn't work that way here. BC's legal framework splits advance planning across multiple documents, each with a different purpose and legal weight — and none of them are called a "living will" under provincial law.

The three documents that matter most:

• Representation Agreement — appoints someone to make health and personal care decisions on your parent's behalf
• Advance Directive — records your parent's own wishes about specific future health care, which clinicians must follow
• MOST form — a clinical order written by a physician that translates your parent's goals into actionable medical instructions

These are complementary, not interchangeable. A Representation Agreement without a MOST form means the representative has to make real-time decisions in a crisis without guidance. A MOST form without a Representation Agreement means the clinical orders exist but nobody has legal authority to update them if circumstances change.

What the MOST Form Actually Does

MOST stands for Medical Orders for Scope of Treatment. It's a standardized clinical form — green-coloured, one page — that a physician completes in conversation with the patient (or their representative). It translates broad values ("I don't want to suffer") into specific medical orders that the doctors and other health-care providers involved in your parent's care can use.

The MOST form covers:

• Resuscitation status — whether to attempt CPR if the heart stops
• Level of medical intervention — comfort measures only, limited intervention, or full treatment
• Assisted ventilation and ICU transfer — whether to intubate or transfer to intensive care
• Artificially administered nutrition and hydration — whether to use feeding tubes or IV fluids

Unlike a Representation Agreement, the MOST form is a medical order. It travels with the patient — in the chart, on the fridge door at home, in the ambulance. It communicates treatment wishes and decisions to the health-care providers involved in the parent's care. If the goal is a legal no-CPR order recognized by first responders, use BC's No CPR Form. A Representation Agreement, by contrast, gives someone authority to make decisions but doesn't tell anyone what those decisions should be.

When to Complete a MOST Form

The MOST form is most useful when a parent has a serious or life-limiting illness or may face treatment decisions during a crisis. That includes your parent if they:

• Have been diagnosed with a progressive illness like advanced dementia, congestive heart failure, or COPD
• Are being admitted to a long-term care facility
• Have had repeated hospital admissions in the past six months
• Are receiving palliative care at home

BC health authorities require a MOST form at the time of long-term care facility admission. If your parent enters a care home without one, the facility physician will initiate the conversation shortly after admission. But having this discussion before a crisis — ideally with your parent's own physician, who knows their medical history — produces a more thoughtful document than completing it under pressure during admission.

How It Connects to Representation Agreements

A Representation Agreement under Section 9 of the Representation Agreement Act gives your parent's representative broad authority over health and personal care decisions. That includes consenting to or refusing treatment, authorizing facility admission, and making end-of-life choices.

The MOST form doesn't replace that authority — it supplements it. When a MOST form is in place, the representative's role becomes clearer: they ensure the clinical team follows the existing orders and update the MOST form when the parent's condition or wishes change. Without a MOST form, the representative has to make those calls from scratch in an emergency room at 3 AM.

If your parent has a Section 7 Representation Agreement (for adults with diminished capacity), the representative's authority over major health care decisions is more limited, and a MOST form becomes even more important as a standing expression of care goals.

Where to Start

Advance care planning in BC works best as a layered process:

1. Have the conversation — Use the free Advance Care Planning workbook from the provincial ACP program to structure a discussion about values and goals
2. Complete a Representation Agreement — Appoint a representative through a Section 9 or Section 7 agreement (Nidus Personal Planning Resource Centre provides free templates and guides)
3. Request a MOST form — Ask your parent's family physician to complete it based on the conversation and the parent's current health status
4. Distribute copies — The MOST form goes on the fridge at home, in the hospital chart, and in the care facility record. The Representation Agreement goes to the representative, the health authority, the family physician, and the care facility

The BC Continuing Care Guide includes a full chapter on legal authority documents — Representation Agreements, EPOA, TSDM, and how they interact with facility admission consent.

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