A Legislative Win for D.C. Residents


Earlier this month, the D.C. Council gave final approval to the Health Care Decisions Act of 2015. This legislation is the culmination of years of work by DC Appleseed’s project team—including the law firms Hughes Hubbard & Reed and Weil, Gotshal & Manges. Throughout the project we relied on the expertise of many diverse community stakeholders including medical professionals, the faith community, and advocates for people with disabilities. We worked closely with Councilmembers and their staff to shepherd the legislation through to passage, and we are grateful for their support and swift action.

This is an important step forward for D.C. residents nearing the end of life. Once the program is implemented, those patients with a life expectancy of around a year or less will be offered the opportunity to fill out a medical order with their healthcare provider that will travel with them as the patient moves between facilities. The form will outline the patient’s choices for medical treatment and end-of-life care based on the patient’s current condition and prognosis.

In the District, this will be called a Medical Order for Scope of Treatment (MOST)—though it goes by many other names across the country, where 45 states have adopted or are currently considering MOST-like programs. This order differs from an advanced directive because a MOST form takes into consideration the patient’s particular medical circumstances, whereas an advanced directive is typically stated in very general terms and is completed years before it will be needed. With a MOST, patients, healthcare providers, and their families can discuss likely interventions, like artificial respiration, a feeding tube, or resuscitation. Patients can ensure that when the time arises healthcare providers will know whether the patient wants all treatment, no treatment, or any possible combination of interventions. This also encourages a more comprehensive consideration of end-of-life care than a do-not-resuscitate order.

This legislation is a big step forward for end-of-life care in the District. Studies show that patients with a MOST form are more likely to have their end-of-life wishes followed. But our work is far from over. The Health Care Decisions Act requires the Department of Health (DOH) to draft the MOST form for use in D.C., as well as develop a training and oversight infrastructure. This will require funding in the District’s FY2017 budget, and collaboration between DOH and community stakeholders to craft strong regulations.

We are looking forward to working with DOH and community stakeholders over the next year to ensure that D.C.’s MOST program is a model for the country. We are proud to have reached this milestone for end-of-life care in the District, ensuring that every patient will have access to important conversations with their providers and families, but there is still much work to be done. We hope you will consider supporting our important work on this project.

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