Without an advance care plan, decisions about your medical care may be made by someone who doesn’t know you or your health care and end-of-life wishes.
When you have an advance care plan, your loved ones won't have to make tough decisions by themselves.
Your advance care plan can also include a Representation Agreement, which allows you to choose a representative to make health decisions for you if you can’t. If you don’t have an appointed representative, your temporary substitute decision-maker will be asked to make decisions for you.
In this article, we’ll go over what advance planning is, how medical decision-making in BC works, what personal planning tools are available to document your future healthcare wishes, and what the legal aspects of BC healthcare planning are.
Introduction to advance care planning in BC
In BC, advance care planning is the process of thinking, documenting, and communicating your health care treatment wishes and end-of-life care instructions in the event you become incapable of deciding for yourself.
An advanced care plan is a legal form that documents your wishes for the type of medical care you want to have if you're badly hurt, have a serious illness, or are unable to communicate your wishes yourself.
Inside an advance care plan, you can also appoint someone as your decision-maker. This person will be called in to make healthcare decisions for you if you can’t. They can also be referred to as a substitute decision-maker or a healthcare representative, agent, or proxy.
Who should fill out an advance care plan?
Advance care planning is important for every adult, no matter what your current health status is. Regardless of your age, it’s really never too early to start an advanced care plan.
In the event something happens that leaves you unable to care for yourself, your healthcare wishes will be legally documented, which helps your loved ones honour your wishes and avoid making difficult decisions.
According to BC legislation, any adult can legally make an advance care plan and appoint representatives and attorneys.
The only exception is if the adult cannot understand the nature and consequences of the proposed documents, such as if they lack all relevant information, if they are under the influence of mind-altering substances, or if they suffer cognitive impairment due to Alzheimer's, dementia, or another condition.
Understanding legal frameworks
Within your advance care plan, there are two forms you can complete to legally document your wishes and appoint people responsible for honouring them: an advance directive and a Representation Agreement. We’ll also explain the difference between these documents and an enduring power of attorney.
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What is an advanced directive in BC?
British Columbia health directives contain your beliefs, values, and wishes, as well as your instructions for health care given to your care provider. It must be legally honoured in the event that you cannot communicate your wishes yourself. If your care instructions are outlined in your advance directive, no one will be asked to make decisions for you.
If a decision needs to be made about something you haven’t considered in your advance directive, someone else will need to make the decision for you. This is where your representative or temporary substitute decision-maker comes in.
It's also important to note that an advance care directive is not a one-time task but a living document. It should be regularly reviewed and updated as your circumstances and wishes change.
What is a Representation Agreement in BC?
In a healthcare Representation Agreement, you appoint someone to make your health and personal care decisions if you ever become incapable of making them yourself. There are two types of forms for Representation Agreements.
The Section 9 type of Representation Agreement allows your named representative to take any step that they consider necessary in relation to your personal care or health care. Under this agreement, your representative can accept or refuse life support or life-prolonging treatment for you.
The Section 7 type of Representation Agreement allows your named representative to help you 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 for the adult and instructing counsel. Under this agreement, your representative cannot refuse life support or life-prolonging treatment for you.
What is an enduring power of attorney in BC?
A BC enduring power of attorney is a document where you legally appoint someone as your attorney to make decisions on your behalf about your financial affairs, business and property. While this document is an important part of your estate plan, it is not part of your advance care directive.
Documenting your healthcare wishes
There are some important things to consider when creating your advance care plan, which we’ll cover in the following four steps:
What are the four steps to advance care planning?
- Reflect on your values, beliefs and wishes. These are things you can document in your advance directive forms for your loved ones and healthcare providers to follow. Here are a few questions to guide you:
- What things make your life meaningful?
- When you think about what your death could be like, what do you take comfort in?
- When you think about dying, what worries you?
- When you are nearing the end of your life, what or who do you want there?
- Decide what you want your healthcare to be like. What kind of end-of-life care options in BC will you accept, and which will you reject?
- Choose your representative and attorney. Who do you want to make decisions about your healthcare and finances in the event that you can’t? They should be an adult you trust, someone who understands your wishes and has your best interests in mind.
- Fill out your documents and put them in a safe place. Write out your wishes, values, and medical decisions in your advance directive. Appoint your healthcare decision-maker in a Representation Agreement. Once the documents have been signed and witnessed, keep them in a safe place, such as a Greensleeve, which you can get from your doctor.
After you’ve completed your documents, it’s important to also talk to your loved ones about your wishes and where you’ve stored your documents. This might also inspire your loved ones, like your parents, spouse, and friends, to create their documents as well.
Other considerations for advance care planning
You may want to also consider spiritual, cultural, emotional, and mental aspects when planning for future healthcare needs. This will help make sure your care is holistic and aligns with your comprehensive sense of well-being.
These things profoundly influence how people perceive illness, make healthcare decisions, and cope with the challenges of medical treatments. By acknowledging and respecting these dimensions of your care, healthcare providers can deliver care that is not only medically appropriate but also personally meaningful and comforting.
Patient rights and decision-making
Your advance care plan is a legal way to state your wishes for health care and at the end of your life. Your advance directive will tell your family and your doctor what to do if you can’t communicate your wishes yourself.
Patient rights in BC healthcare dictate that patients need to provide informed consent to be treated. This means your healthcare provider must inform you of your diagnosis, including what treatment or health care they suggest, what the benefits and risks of treatment are, and any other treatment options, and you must consent for your treatment to move forward.
Medical Orders for Scope of Treatment (MOST) are medical orders that communicates a patient's treatment wishes and decisions to healthcare providers. Completed by a doctor or nurse practitioner after discussions with the patient about their goals of care, values, and preferences, a MOST form specifies the level of medical interventions desired in case of an emergency or if the patient is unable to express their wishes later.
- If you are unable to consent and did not have a MOST form filled out, someone must make the decision for you.
- If you have an advance care plan, including an advance directive, you’ve already outlined your wishes, and no one needs to make them for you.
- If you haven’t outlined your decisions in an advance directive, your appointed Representative will make decisions for you.
- If you have no advance directive and no appointed Representative, a temporary substitute decision-maker will be asked to make decisions for you.
Who can be a temporary substitute decision-maker?
BC law determines who can qualify to be on your list as a temporary substitute decision-maker (TSDM). To qualify, the person must be an adult (19 or older) who is capable of making decisions and has been in contact with you within the past year. They must also have no dispute with you.
The order of the TSDM list that your doctor or other health care provider receives is based on family law and cannot be changed:
- Your spouse (married, common-law)
- Your child
- Your parent or legal guardian
- Your sibling
- Your grandparent
- Your grandchild
- Anyone else related to you by birth or adoption
- Your close friend
- A person immediately related to you by marriage (in-laws, step-parents, step-children, etc.)
If you do not like the order of your TSDM list or have someone else you would like to be your decision-maker instead, you will need to make a Representation Agreement to name them as your representative and primary decision-maker.
What is the difference between goals of care and advance care planning?
Goals of care conversations focus on making specific decisions about medical treatment in the context of your current health situation, addressing immediate and short-term healthcare needs.
Advance care planning, on the other hand, involves outlining your wishes for medical treatment in hypothetical future scenarios, ensuring your preferences are known if you become unable to communicate.
Why advance care planning is important
Advance care planning is important because it ensures that you receive medical care that is aligned with your values and preferences if you ever become unable to communicate your wishes. Having a plan in place not only provides peace of mind for you as a patient, knowing that your healthcare decisions will be respected, it also lifts the emotional burden on your family, reducing stress, anxiety, and potential conflicts during critical moments of your care.
Advance care planning also promotes patient-centred care, improves the quality of end-of-life care, and can lead to better health outcomes by preventing unwanted medical interventions and facilitating the use of palliative and hospice services.
It makes sure that everyone is informed and prepared for future healthcare decisions.
Tools for personal planning
Willful offers resources to support your personal planning, including guides, estate planning checklists, and a team of certified estate planning experts to help you if you have any questions.
Start making your legal will and power of attorney documents with ease.
In addition to this article, you can also read more about BC personal planning tools with these articles:
- End-of-Life Planning: The Definitive Guide
- A Guide to Estate Planning in BC
- What You Should Know About Making A Power of Attorney in BC
- The Complete BC Executor Guide
Other helpful resources for your personal planning include BC’s official guide on advance care planning, My Voice: Expressing My Wishes for Future Health Care Treatment, and the quick guide version, My Voice Advance Care Planning Guide Quick Tips.
How do you initiate advance care planning?
Making your advance care documents is simple and affordable.
You can easily appoint your chosen decision-makers in your will, Representative Agreement, and enduring power of attorney documents today with an online legal document platform like Willful.
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