Advance Care Planning is for Everyone

Alex Muir

An Advance Care Plan (ACP) is a helpful tool that walks you through questions and considerations having to do with emergency and end-of-life care. The purpose of the ACP Kit is to help you get in touch with and express your wishes regarding your future health care decisions.

Those wishes and details can then be included in the creation of specific legal documents. • Section 9 or Section 7

Representation Agreement • Advance Health Care Directive

Note: At the present time,

Medical Assistance in Dying (MAiD) cannot be included in those documents. • Power of Attorney or Enduring

Power of Attorney If you have a Representation Agreement, you will have chosen a Representative to make some decisions on your behalf if you become incapacitated, Your Representative should be a person very familiar with your beliefs, values, and wishes regarding your future health care treatment so he or she can make an informed decision based on what you would want in the situation.

If you don’t have a Representative, a temporary substitute decision-maker (TSDM) will be chosen by your medical team. According to BC law, one individual must be approached— in the following order. 1. Your spouse (married, common law, same sex—length of time living together doesn’t matter) 2. Son or daughter (19 or older, birth order doesn’t matter) 3. Parent (either, may be adoptive) 4. Brother or sister (birth order doesn’t matter) 5. Grandparent 6. Grandchild (birth order doesn’t matter) 7. Anyone else related to you by birth or adoption 8. Close friend 9. Person immediately related to you by marriage (in-laws, stepparents, step-children, etc.) If you know you would want someone lower on the list to be your TSDM, you should legally name that person as your Representative in a Representation Agreement. It is recommended that you choose an alternate Representative as a backup. The person(s) you choose must agree to be your Representative.

Two types of Representation Agreement formats are in use in British Columbia. The BC government has specific Representation Agreement templates available, although some lawyers have developed their own formats; the completed forms must be witnessed by two people. Only one witness is required if the witness is a member-in-goodstanding of The Society of Notaries Public of BC or a lawyer.

The Section 7 Agreement allows the Representative to make personal care and some health care decisions as well as basic financial decisions. It does not allow the Representative to accept or refuse life support or life-prolonging medical interventions.

Both types of Representation Agreements are available • online in the BC Government publication, “My Voice:

Expressing My Wishes for

Future Healthcare Treatment,” and • through your local BC Notary and lawyer.

Section 9 Representation Agreement

Most people appoint a Representative through completing a “Section 9 Enhanced Representation Agreement.” That legal document allows the adult to name a person who can make personal care decisions and some health care decisions for the adult, including decisions to accept or refuse life support or life-prolonging medical interventions.

Section 7 Representation Agreement

Less common is the “Section 7 Standard Representation Agreement” that allows an adult with a lower level of capability— due to a developmental disability or injury/illness of the brain that affects cognitive ability—to do some advance planning. The Section 7 Agreement allows the Representative to make personal care and some health care decisions as well as basic financial decisions. It does not allow the Representative to accept or refuse life support or life-prolonging medical interventions.

This question often arises: How will hospital health care teams know you have a Representation Agreement and a Representative and/or an Advance Health Care Directive? We advise the following steps. 1. Have vital conversations with your loved ones, your Representative, and your health care team. 2. Complete a Representation

Agreement. Provide a copy of it and your Advance

Health Care Directive to your

Representative and your primary health care provider. Ask your

Representative to take those documents to the hospital when the time comes. 3. Paramedics are trained to look on the fridge for important medical documents. Either put your Representation

Agreement and Advance Health

Care Directive on the fridge or put a note on the fridge indicating where those legal documents can be found by the paramedics. 4. Ask your family physician to scan your documents and put them in your medical file. 5. You may also wish to upload those documents to a central repository, such as Nidus.ca or

CARP Health 360. Connie Jorsvik, a Vancouver-based BSN health care navigator and owner of Patient Pathways, offers detailed advice and guidance in her book Advance Care Planning, in which she states, “Advance care planning is for all adults of all ages and all stages of health. The earlier we begin those conversations, and the planning that goes along with them, the more natural, less scary, and less fraught with emotion the planning process is.”

Make sure to revisit your legal documents and ACP Kit every 3 years or when your medical situation changes. Most important, make sure the people close to you are aware of your values and wishes. Choose a Representative who will honour them. s https://www.dyingwithdignity.ca/ education-resources/advance-careplanning-kit/ Alex Muir is Chair, Metro Vancouver Chapter, Dying With Dignity Canada (www.dyingwithdignity.ca).