Advance Care Planning

Advance Directive is a legal document that includes your written instructions for consent or refusal of health-care treatment options. If you have chosen a substitute decision maker, they must follow the instructions in your advance directive.

The legal requirements for an advance directive are that it be in writing and signed by you when you are capable, and that it be witnessed by two adults or one person if the witness is a lawyer or notary public.

The witnesses must:

• Be 19 years of age or older
• Be able to understand the type of communication or language you use, unless an interpreter is present
• Not be a person who provides paid personal care, health-care or financial services to you (other than a practicing lawyer or notary public) or be that paid person’s spouse, child, parent or employee

It is recommended that you provide a copy of your advance directive to members of your family and health-care team who are leading your care (e.g., your physician/nurse practitioner, home care nurse).

Download Advance Directive

Representation agreements are legal documents that allow you to plan for the possibility of future incapability. These are tools that allow adults to name another person to manage their personal and health-care needs and financial matters in the event they are not able to on their own. There are two types of Representation Agreements: Section 7 and Section 9.

With the Representation Agreement (Section 7) Form you may name a representative to help make decisions or make decisions on your behalf, with respect to personal care and health care, the routine management of financial affairs and obtaining legal services and instructing counsel. Section 7 Representation Agreements cannot:

• Make, or help you make, decisions to refuse health care necessary to preserve life 
• Physically restrain, move or manage you (or allow someone else to do so
• Make decisions about admission to facility-based care (e.g., nursing home, long-term care).

With the Representation Agreement (Section 9) Form you may name a representative to do anything that the representative considers necessary in relation to your personal care or health care, including any of the following:

• Decide where you are to live and with whom, including whether you should live in a care facility
• Decide whether you should work and, if so, the type of work, the employer, and any related matters
• Decide whether you should participate in any educational, social, vocational or other activity
• Decide whether you should have contact or associate with another person
• Decide whether you should apply for any licence, permit, approval or other authorization required by law for the performance of an activity
• Make day-to-day decisions on your behalf, including decisions about your diet or dressz
• Give or refuse consent for your health care, even if you refuse to give consent at the time the health care is provided
• Despite any objection by you, physically restrain, move and manage you, and authorize another person to do these things, if necessary to provide personal care or health care to you

Your representative does not have the authority, unless specifically stated in the representation agreement:

• To make arrangements for the temporary care and education of your minor children, or any other persons your care for or support
• To interfere with your religious practices
• To make decisions identified under section 34 (2) (f) of the Health Care (Consent) and Care Facility (Admission) Act

In a representation agreement made under this section, if a representative is provided the power to give or refuse consent to health care for the adult, the representative may give or refuse consent to health care necessary to preserve life.

More information can be found at Representative Agreements and Enduring Power of Attorney.

A power of attorney and an enduring power of attorney are legal documents that appoint one or more persons to handle your financial and legal affairs. In this case, "attorney" does not mean a lawyer. Your attorney could be your spouse, a family member or close friend whom you trust implicitly. Neither power of attorney nor enduring power of attorney covers personal or health-care matters.

The power of attorney is only valid while you are capable to make your own decisions. The authority of the power of attorney ends as soon as you become unable to make decisions for yourself.

The authority of the enduring power of attorney is valid while you can make your own decisions remains in place if you become unable to make decisions for yourself.

You may choose to have both a power of attorney and an enduring power of attorney. Your attorney can be the same person. You can restrict or limit your attorney to specific dates and/or tasks.

A substitute decision maker (SDM) is a person you choose in advance to make health-care decisions for you in the event that you can't make them for yourself, e.g. at end of life or if you are severely injured or during other medical emergencies.

You appoint your SDM by completing a Representation Agreement (Section 7) form and/or a Representation Agreement (Section 9) form. In general, an SDM can agree to or refuse treatment and can withdraw treatment on your behalf. Your SDM can use the information in your advance care plan, statements made by you in the past, and what he or she knows about you personally to make these decisions. Be sure to note there are different decision-making authorities given to the SDM depending on which representation agreement you complete. The laws regarding a substitute decision maker vary from province to province.

A temporary substitute decision maker (TSDM) is chosen by the health-care team if you have not legally named an individual (representative) to make health-care decisions for you when you are incapable of making them yourself. The TSDM is chosen by the health-care provider from an ordered list that is determined by B.C. law.

To be able to act as a TSDM, the person must be 19 or older, be capable, have no dispute with you, and have been in contact with you in the past year. In the absence of a Representation Agreement, the health-care provider will contact the individuals below in this order:

1. Your spouse (married, common-law)
2. An adult child (19 or older, birth order doesn’t matter)
3. A parent
4. A sibling (birth order doesn’t matter)
5. A grandparent
6. A grandchild (birth order doesn’t matter)
7. Anyone else related to you by birth or adoption
8. A close friend
9. A person immediately related to you by marriage

You may not change the order of this list. A person lower down on the list may only be chosen as your TSDM if all the people above them do not qualify or are not available. If you know that you want someone lower on the list to make your health-care decisions, then you should legally name that person as your representative using a Rep 7 or Rep 9 agreement.

A TSDM has limited authority and is selected on a decision-by-decision basis. More information can be found at the Public Guardian and Trustee of British Columbia website.

If you become incapable and have not already named someone to make decisions for you, the B.C. Supreme Court may appoint someone close to you or the Public Guardian and Trustee of British Columbia to make decisions on your behalf. There are two types of committeeship:

• A committee of person makes decisions on your behalf regarding your personal care, health care, and living arrangements of you and/or your dependents, if you are not capable of making these decisions yourself.
• A committee of estate has full responsibility for your financial and legal affairs.

More information and resources can be found on the Public Guardian and Trustee of British Columbia website.

When you learn that you have an illness that may shorten your life, you may want to speak with your physician or nurse practitioner about receiving care that will help you stay comfortable without prolonging your life. You may also talk about whether you want to be revived (resuscitated) when your illness reaches its last stages and your heart and breathing stop. In any medically urgent situation, especially when you cannot speak for yourself, it’s important that the health-care team understands your expressed wishes for treatment and care.

If you have completed an advance directive or an advance care plan, they should align with your MOST designation. If you have both an advance directive and a MOST, the health-care team, by law, must follow what you have written in your advance directive.

Talking with your physician or nurse practitioner about care at the end of life will help you to better understand.

• Your health condition
• Possible treatment choices
• Options for care that are best for you
• Which MOST designation best reflects your situation

The results of these discussions will be your physician or nurse practitioner completing the MOST Form with you.

Access the Medical Orders for Scope of Treatment form

• MOST Goals of Care
• MOST Definitions
• MOST FAQ Public Resource
• MOST Brochure
• Overview of the MOST Designation Form
• Video: Patient-Centred Care - An Approach to Support MOST
• Video: Having a MOST Discussion - A 3-Step Process
• Video: Advance Care Planning (ACP) and MOST - Information for Patients