IT’S HARDER THAN YOU THINK!
Part 1- The MOST form
If you wish to declare No CPR Status, you and your medical provider should fill out a MOST form in Colorado. MOST stands for Medical Orders for Scope of Treatment. It goes by other names in other states (POLST, MOLST, POST) but has the same purpose. It defines a few specific End-of-Life issues. It is typically bright green and it can be any copied color. Green makes it easy to see in a medical chart, in a purse, or on the refrigerator.
In today’s climate, it is important to have the MOST available to any first responders when the request is DO NOT RESUSCITATE. If Resuscitation is preferred, there is no real need for an order, as resuscitation is the default action. If someone wants to have a more natural, peaceful passing, sometimes called “Allow Natural Death” (AND), the right thing to check is NO CPR. This selection includes comfort measures such as oxygen, comfortable positioning, and management of pain.
Be sure that you check COMFORT CARE, (NOT FULL TREATMENT or SELECTIVE TREATMENT) in the second section on the form. If you fill this out incorrectly, the answers call into question the real intent.
The trick to avoiding CPR is to carry this piece of paper signed by the physician wth you at all times. Yes, in the grocery store. Yes, on the bus. Yes, to the gym. Yes, to the Dentist.
Any caregiver should also carry a copy and understand the intent. If there is a home health aide taking the individual who wants to avoid CPR to the doctor, that individual must carry a copy of the form. Keep several copies… even one in the glove box. Why? CPR will be started by a bystander who knows CPR or any first responder, unless you can prove the order. To halt this, show the MOST that you have with you (that you are smart enough to carry with you!) If you are always at home, and the MOST is on the refrigerator or in your hand when a first responder comes you don’t need copies. But, many of us go out for one reason or another so have a copy handy to take along.
One more important note on this topic – DO NOT PUT THIS FORM IN A SAFE DEPOSIT BOX! Don’t hide it. This isn’t your deed to the house! It has to be available in an emergency, and people have to know where it is in a split second.
Someday soon there will be changes to this. For now, this is the story! Our amazing first responders who do out-of-hospital care will do everything they can for you. If you follow their rules they will follow yours. So, go get your MOST form and make it your companion if you want to say NO to CPR.
Part 2- The Medical Power of Attorney and CPR
Most of us know that CPR is a very aggressive treatment to try to save a life. And it works in some cases – typically for those who are younger and more healthy. (The golf course lightening strike is a good example.)
If what you know about CPR is from Medical TV shows, your idea of the success rate is probably pretty far from what occurs in real life. The success rate is dismal in the elderly, people who are terminally ill, those who are frail, those with organs that are failing. It is exceptionally hard on the bones, organs, brain…and an ICU stay will follow if you regain a heartbeat. Remember, CPR is never started unless you have no pulse or respirations – you have already passed on.
It is important to have formally chosen a Medical Power of Attorney. If not, decision making can be a “free for all” with “interested parties welcome to weigh in.” Not a good idea. The Medical Power of Attorney is a spokesperson for medical concerns only.
The “job” of a Medical Power of Attorney starts when you can’t think clearly for yourself. This may be because of a head injury, or medication that makes you unable to think straight. It may be temporary or permanent. The responsibility ends at your last breath.
The kinds of decisions a Medical Power of Attorney might have to make are serious ones. Here are a few of the categories: tests, minor or major surgeries, medicines, tube feeding, ventilator use, removal from life support, palliative care, hospice. This responsibility is not an “honor” for the first born. Choose someone who you feel will stand up for your decisions as they best understand them. Choose someone who can be available and is willing to talk with you in advance to understand your fears and goals.
The “Medical Power of Attorney” is known by many names:
Medical Durable Power of Attorney is the formal name. (MDPOA)
Medical Power of Attorney
Medical Decision Maker
Surrogate Decision Maker
Medical Spokesperson… and more
The document to formally choose your Medical Power of Attorney is available on the internet:
As you can see on the form, there should be 2 documented alternates in the event that your main spokesperson isn’t available. This is designed so that there is one person with the final decision. The alternates are welcome to weigh in, but the ultimate decision is up to the Medical Power of Attorney.
Discuss the important decision about CPR with your Medical Provider. If you or a loved one are not currently able to make decisions, be certain the medical spokesperson is there as well for the conversation.