The general rule of thumb is that in cases of conflict between a MOST and other advance directives, the most recent document rules. However, there are some nuances to this, depending on who has completed which document when:
- The MOST and CPR directives: If a person completed a CPR directive (refusing CPR) before completing a MOST, but then on the MOST says “Yes” to CPR; the most recent document prevails. If the person completed a CPR directive (refusing CPR), and later is incapacitated and the MOST is completed by the person’s Healthcare Agent choosing “Yes CPR,” the prior CPR directive prevails: Healthcare Agents cannot revoke or overrule a CPR directive completed by a competent patient.
- The MOST and living wills: A Healthcare Agent cannot complete a living will for an incapacitated patient. Likewise, a Healthcare Agent cannot override or revoke the person’s living will unless specific authority to do so is stated in the living will or the MDPOA document. If the Healthcare Agent completes a MOST for the person and a previously completed living will contradicts any of the MOST provisions, the living will prevails. If the patient completes a MOST for him/herself and a previously completed living will contradicts the MOST, the MOST prevails.
IMPORTANT: This is why it is essential, before completing a MOST, to ask the patient about previously completed advance directives to make sure the documents do not conflict.