Advance Care Planning

Advance care planning helps you to:

• THINK about your values, beliefs and wishes

• HONOUR your personal, cultural and/or spiritual traditions

• TALK with your family about your wishes and instructions

• GUIDE your health-care team to give you the care that is right for you, such as:

  • Goals of care – a medical order used to describe and communicate the general aim or focus of care including the preferred location of that care

  • Medical orders for scope of treatment (MOST) – a way for your physician to communicate your treatment wishes and decisions with other physicians and health-care providers who may be involved in your care

• DECIDE who you want to speak for you, if you are not able to speak for yourself

• RECORD your wishes

• HAVE peace of mind that your financial and legal affairs are in order

We make our best decisions when we are calm and able to set time aside to think about what matters most to us. It is helpful to think and talk about advance care planning before we are in a stressful situation or medical crisis. Even if you’re feeling well and healthy now, it’s a good idea to be prepared in case you become suddenly unwell and not able to make decisions for yourself.

If you do not talk about your wishes or write down your instructions, your loved ones and health-care team will be left to make decisions for you that they believe are in your best interest. Completing your advance care plan helps to avoid unwanted medical treatments or unintended conflicts between loved ones. The B.C. Ministry of Health encourages all adults to think about advance care planning. A variety of resources are available on the Ministry’s website.

A ground-breaking video challenges the commonly held perception that a loving relationship is all you need to ensure your end-of life-wishes will be met. Produced for Advance Care Planning Australia (ACPA) by the award-winning Creativa video production agency, the Love is Not Enough video introduces two couples and one father and daughter, testing how well they know their loved ones.

An advance care plan is made up of documents that record your specific health-care wishes and instructions. 

An advance care plan includes a range of topics from:

• Personal beliefs, values and wishes

• Health-care treatment options

• Assignment of representatives (substitute decision maker) to help with financial and health-care decisions

• Legal written health-care instructions (advance directive)  

Your advance care plan would be used by your health-care team and/or substitute decision maker to guide decisions in the event you are unable to make them for yourself. You can change your mind about treatment, including changing or cancelling your advance care plan at any time. There is no formal advance care plan template in British Columbia.

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).

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.

• 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

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 dress

• 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 and 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 the end of life or if you are severely injured or during other medical emergencies).

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. For example, your SDM can consent to surgery, refuse to have you placed on life-support machines or request that you be taken off life support.

The legal document that grants this decision-making power to the person you select may be called a representation agreement. The court may also appoint a substitute decision maker through the process of Committee of Person. In general, the laws regarding a substitute decision-maker vary from province to province.

The health-care provider may choose a temporary substitute decision maker if you did not authorize an SDM. 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.

There are a number of resources that can help you start the conversation about advance care planning:

• Advance Care Planning (BC Centre for Palliative Care)

• Advance Care Planning (BC Ministry of Health)

• Video: My Voice - Expressing My Wishes (BC Ministry of Health)

• Approach to Decision Making & Advance Care Planning (Canadian Virtual Hospice)

• Advance Care Planning Across Canada (Canadian Virtual Hospice)

• Living My Culture (Canadian Virtual Hospice)

• Advance Care Planning  (First Nations Health Authority)

• Your Care, Your Choices (First Nations Health Authority)

• What is Advance Care Planning? (HealthLink BC)

• Advance Care Planning: What to Include (HealthLink BC)

• Care at the End of Life (HealthLink BC)

• Nidus

• Public Guardian and Trustee of British Columbia

• Advance Care Planning (Seniors BC)

• Seniors First BC

• Advance Care Planning Canada