A DMOST form has six sections, A – F. Each of these sections tells your health care provider something different about your goals, values, and decisions.
Section A discusses your goals of care. This is the only section on the DMOST form that is not a medical order. In section A, you can say things like “I want to play 9 holes of golf,” or, “I want to attend my granddaughter’s birthday party.” Discussing your goals of care with your health care team helps them understand where you are coming from, and helps them help you make the best decisions for your care.
Section B discusses your goals for Cardiopulmonary Resuscitation, or CPR. CPR is given when your heart stops beating and you stop breathing. It can consist of pushing on your chest and breathing into your mouth for you, but can also include shocking your heart to get it to beat and a machine breathing for you. Do Not Resuscitate means that if you are found with no pulse and are not breathing, medical teams will not do CPR to try and get your heart beating again. They will keep you comfortable until you die a natural death.
In section C, your medical team will discuss different levels of treatment options with you. If you chose CPR in section B, you MUST choose Full Treatment in section C. Electrical stimulation of your heart and machines breathing for you are called Advanced Cardiac Life Support, or ACLS. ACLS must occur in the Intensive Care Unit (ICU) of a hospital.
Choosing Do Not Resuscitate (DNR) in section B does NOT mean you may not choose Full Treatment in section C. You may wish to have everything possible done to keep you alive until such time that you are found with no pulse and not breathing. At that time, you may wish to be kept comfortable until you die a natural death.
In discussing section C, your medical team may also talk about dialysis, chemotherapy, or antibiotics for infections. You may base your decisions on the type of treatment, OR the location of treatment – full treatment may require a hospital stay, partial treatment may mean staying in some form of long term care facility – you should discuss these options with your health care team. Comfort measures will ALWAYS be given, even if you choose to stay at home.
Your health care team will also discuss artificial hydration and nutrition with you. They should let you know that hydration and nutrition will ALWAYS be offered by mouth first if it is feasible. An IV may be inserted into your vein to provide adequate hydration, if you choose it.
There are two ways of giving you nutrition artificially: NG tubes and PEG tubes. Your health team should discuss both of these options with you, but in short:
An NG (Naso-Gastric) Tube goes from your nose into your stomach. Food is liquefied and passed to your stomach this way if you have problems chewing or swallowing.
A PEG (percutaneous endoscopic gastrostomy) tube is surgically inserted into your stomach. Liquefied food is then injected directly into your stomach, bypassing the mouth and throat entirely.
Artificial nutrition and hydration may be tried for a certain time, after which you may elect to stop them, this is called a “time trial.” If this is something you feel you might like to try, you should discuss it with your health care team.
In section E, you may identify an Authorized Representative. This person may make changes to your DMOST form if you allow them, and may discuss your treatments with your health care team.
The final section of the DMOST form is section F. Here, you must sign the form, stating you consent to the treatment options outlined on the form. Your doctor, advance practice nurse, or physician assistant will sign after you, making the form medical orders that must be honored in every hospice, hospital, long term care facility, ambulance, or other medical institution in the state of Delaware.
- This form, and your Authorized Representative, will NOT be consulted unless you cannot communicate with the health care team.
- You must keep this form with you, in a pink envelope your health care team will give you, at all times. Talk to your family about your decisions and let them read the form.
- You may revoke or change your DMOST at any time – just call your health care team. They will assist you in filling out a new DMOST with your new wishes, or revoking an old form.