Advance Care Planning
All adults benefit from the peace-of-mind that can result from advance care planning (ACP) for a possible time when they are no longer able to direct their own medical care. This is especially true for people who have been diagnosed with a life-threatening or terminal illness and for people in their senior years.
Doing medical pre-planning can ensure your wishes are followed and alleviate stress for family members and prevent unnecessary family suffering and conflict. Physicians and other health care professionals also benefit from knowing that they are acting in accordance with your wishes.
My Voice, is BC’s guide to Advance Care Planning, complete with necessary forms and detailed instructions.
Speak Up, is the booklet provided by the Canadian government. It provokes thought with many interesting questions.
In British Columbia, the Representation Agreement Act, which came into effect in 2000, is a mechanism by which adults can name a Representative to make decisions for them, if, by reason of injury or disease, they are no longer able to make their own decisions. The person (or persons) designated can make legal, financial, personal care and medical decisions. This Act also states that the Representative(s) must make the decisions in accordance with the person’s expressed wishes and instructions.
If there is no Representation Agreement, the Health Care Consent Act names the next-of-kin as a substitute decision maker for people who are not able to give or withhold consent to medical treatment. This legislation also states that decisions made by the substitute decision maker have to be in accordance with the person’s expressed wishes and instructions.
In situations where conflict between family members is possible, or if your next-of-kin does not share your values and beliefs, it is extremely crucial that you do the necessary pre-planning to address your needs.
It is important for people to consider what treatments they might or might not want under various medical situations should they not be able to direct their own care.
Such instructions are known as advance medical directives — you are making medical choices in advance that only have relevance while you are still living. To address this issue, gather information, consider the options and discuss your thoughts with your family physician, your family, a friend, or a Hospice volunteer.
Advance Directives, and Representation Agreements
Advance directives and substitute decision-making agreements like representation agreements are documents that will allow the person of your choice to make important health care decisions for you in a medical crisis, if you’re not able to make those decisions yourself.
In British Columbia, Do Not Resuscitate orders (DNRs) are a type of advance directive indicating that you do not want cardiopulmonary resuscitation if you stop breathing or if your heart stops beating. People who have a terminal illness or are at the natural end of their life can make this request. This should be done after discussions with your doctor as the form needs to be signed by your doctor. It is important to remember that this document applies only to cardiopulmonary resuscitation.
Although BC Legislation says that your wishes, whether verbal or written, must be followed, you have much better protection if your wishes are written. It is also important for all the people close to you and your doctor(s) to know that you have written an advance directive and for them to have a copy or know how to find it. Your wishes can only be followed if people know them. Do NOT put your advance directive in a safety deposit box as it may not be accessible when it is needed.
Currently there is no standardized advance directive form to use and some types that exist are not very useful because they are unclear and/or incomplete. The more detail you provide, the more you will be recognized as an informed consumer of medical care, and the more likely it is that your wishes will be followed. The Canadian Medical Association directs physicians to follow advance directives, and doctors have been successfully sued for not doing so.
If you make a Representation Agreement, you may have your advance medical directive as part of the Agreement or as a separate document you would attach to it.
It is also important to remember that these documents are a form of “insurance” and may never come into effect. If you remain able to direct your own affairs and give or withhold consent to medical treatment, they will never have to be used. Having them in place, however, provides you, your family or loved ones with peace-of-mind should the need ever arise.