Advance care planning

Advance Care Planning means that we decide what medical care we might want if we become unable to make or to express our choices. Written instructions for our future medical preferences have many names, such as Living Wills, Advance Medical Directives, Representation Agreements, Power of Attorney for Personal Care, Health Care Preplanning and others.

The terminology, documents, and laws concerning end of life decision making varies across Canada. In British Columbia, the term Advance Care Planning is used.

We are all unable to know what may happen to us and what our future medical needs will be. As long as we are able to communicate the choices we make for our medical care, we will be asked to make our own decisions. But some conditions affect our ability to make or to express choices we might make. If severe illness, accident, or the dying process makes us unable to understand or to express our choices, a written plan provides guidelines to family/loved ones and medical personnel who will have to make decisions for us. We can specify which kind of treatments and care would be acceptable to us, based on our values and beliefs; and which types of medical interventions we do not want.

In 2011, legislation in BC was amended to make Representation Agreements a legally binding form of Advance Care Planning. A booklet/download put out by BC’s Ministry of Health called My Voice describes the paper work involved in creating a Representation Agreement, and includes the required forms. It is not necessary to consult a physician or lawyer, and no cost is involved.

The Representation Agreement requires us to specify who we wish to make decisions for us. There is a legally designated order for decision makers if we do not choose one ourselves.

Secondly, the Representation Agreement requests that we write down our values, beliefs and wishes, so that future decision making can be based on these very personal viewpoints.

Thirdly, the Representation Agreement asks for our instructions. These are the kind of choices we might make for ourselves if we were able to, but which our allocated decision maker will have to make for us if we are no longer able.

However the space allocated for instructions in My Voice is small. While it is impossible to cover all situations in which we might find ourselves, it is helpful to consider examples of what could occur, and specify what we might choose for our care under these circumstances. In particular, they allow us to decide ahead if we do not wish to receive medical treatments which may merely prolong our dying. This does not mean that all types of medical care would be withdrawn, so comfort care and pain relief would still be provided.

The University of Toronto’s Joint Center for Bioethics Living Will addresses the medical issues in considerable detail. This may be downloaded, carefully read, and if desired the decision making grid may be filled out and attached to your My Voice documents.

Completion of Advance Care Planning brings peace of mind, and a lessening of fear for the future. At the time they may be required, these documents can greatly reduce stress for family and medical caregivers. This can be a gift to those who are left to make decisions for us at a very difficult time. Where disagreement within the family about medical care is likely, or your next-of-kin does not share your values and beliefs, advance medical directives can prevent unnecessary family conflict. Decision making by health care professionals is also less complex when they know what your wishes are. We only need to complete the documents once; then we can invest our energy in living life to the fullest.

Other recommended documents to complete End of Life planning:
1. A Will, which allocates our property and possessions after our death.

2. Appointment of an Enduring Power of Attorney, who will make legal and financial decisions for us if we become unable to do so.

3. Funeral Preplanning, on this site under Funeral Planning and Last Wishes Society.


Advance Care Planning in BC:
My Voice re Representation Agreement University of Toronto
Joint Center for Bioethics Living Will
Nidus website
MedicAlert website
New Denver Home Care Nurse 250 358 7804.