Planning for end of life
Have the conversation with your loved ones before it’s too late
April 16 is Advance Care Planning Day.
It’s not an occasion many people recognize, but it is a valuable opportunity to start a conversation with your family.
Advance care planning is about reflecting on and communicating personal care preferences. The goal is to help your loved ones understand your wishes in case you become incapable of making medical treatment decisions.
People often find it difficult to talk about death and dying. These fears may prevent us from engaging in advance care planning.
The process doesn’t have to be scary though. There are lots of resources available to assist in these conversations.
Two of the most critical components of advance care planning are identifying a substitute decision maker (SDM), an individual chosen to make medical decisions on behalf of another person if they are unable to do so for themselves, and communicating your wishes, values and health preferences with them.
Discussing the information below with your substitute decision maker may make it easier for them to make health care choices on your behalf:
• What do you value most in life and that brings joy to your day?
• What would you want your health care team to know about you that will help to determine your medical goals of care?
• How important is it to be able to eat and would you want a feeding tube to provide nutrition if you are not expected to regain your ability to take food by mouth?
• Would you want a breathing tube if your lungs or heart began to fail?
• Should your heart be restarted if it begins to fail?
• Where would you want to live if you can no longer care for yourself in your own home?
The Health Care Consent Act provides a ranked list of people who can be a patient’s SDM. The person who is highest on the list, who is capable, willing, and available to act as SDM should be approached for health care decisions. An SDM can be:
• The incapable patient’s guardian, if he/she has authority to give/refuse consent for treatment; i.e. court appointed individual or agency
• The incapable patient’s attorney for personal care (POA), if he/she has authority to give/ refuse consent for treatment
• The incapable patient’s spouse or partner
• The incapable patient’s child or parent (or Children’s Aid Society or other lawfully entitled person able to give or refuse consent for treatment in place of the parent. Note: If the Children’s Aid Society or other person has this authority, the parent is not included in this ranking.)
• The incapable patient’s parent who has only a right of access
• The incapable patient’s brother or sister
• Any other relative of the incapable patient
The Office of the Public Guardian & Trustee addresses situations where there is no willing and available SDM, or there are two or more equally ranking SDMs who disagree regarding a decision for a patient or where they have been appointed by the courts.
A POA is a person identified by the patient, in writing, as their decision maker for personal care, should they become incapable. They are the first ranking person in the list of substitute decision makers. If there is no a courtappointed SDM, and the patient has not identified a POA, then an SDM is determined using the ranking order above.
When someone becomes an SDM, it is important for them to consider the person’s wishes and to act in their best interests. Substitute decision makers should ask themselves the following questions to ensure they are acting on the wishes of the person they’re representing.
• Do I understand what’s important to my loved one?
• Do I know their health and personal care wishes?
• Am I willing to communicate those wishes, even if they aren’t what I would choose?
• Am I able to communicate clearly with health care professionals and ask questions?
• Can I make difficult decisions, even during stressful times?
• Do I know the legal requirements of my roles as a substitute decision maker?
If you have questions about advance care planning for yourself or a loved one, speak with your family doctor or hospital care team, or visit advancecareplanning.ca.