A personal directive allows you to state what you would want for medical care, and preferences about where you would want to receive it. It also allows you to name someone you trust (your agent) to make decisions on your behalf if you can no longer do so. With this document, your agent can make decisions that are in accord with what you would want. It also helps a health care team recommend treatments that match your wishes. A personal directive can help you feel confident that future medical decisions will be based on your values, wishes and beliefs.

Your agent should have a copy of your personal directive. Share it with your family doctor as well. If you are admitted to a hospital or a long-term care facility, your personal directive should be supplied to your health care team. It gives information about your wishes to health care staff, in case you cannot speak for yourself.

Review your personal directive regularly to be sure that it continues to reflect your feelings, beliefs and values about your future care.

A personal directive is a legal document. It is not necessary to use a lawyer to make one. However, for it to be valid, there are legal requirements. Each province and territory has specific legislation to support the creation of a personal directive.

Who will speak for you?

In Canada, many people have not considered planning for their future in this way. A March 2012 Ipsos-Reid national poll found that 86 per cent of Canadians had not heard of advance care planning. Less than half had had a conversation with a family member or friend about health care treatments they would or would not want if they were unable to communicate due to illness.

Results from the multi-year Advance Care Planning Evaluation in Hospitalized Elderly Patients (ACCEPT) study reveal that the correct preferences for patients’ end of life care were written in their medical records only 30 per cent of the time. Nearly half of the patients had completed an advance care plan, and almost three-quarters had named a substitute decision maker. However, only 30 per cent had told their doctor about it.
Many names for advance care planning and personal directives are used. Health care directive, advance care directive, and goals of care are some other terms used. The term ‘living will’ is from the United States. It has been adopted into everyday language. It typically refers to any kind of advance care planning document. The term living will is not in Canada’s health care consent legislation. However, it is generally accepted to mean a person’s wishes for future health care.

Points to consider

Creating a personal directive gives you an opportunity to think about what you would want for care if anything happened to you. You can discuss your decisions with your agent, family member and caregivers.
Would you want to receive artificial nutrition at the end of life?
Would you want to be on a respirator (breathing machine) if you were unlikely to recover or were in a permanent coma?
If you had a terminal illness, would you want medical treatments to prolong your life or only medications to keep you comfortable?
What would you like for supports to continue to live in your own home? What other options would you prefer if living at home became difficult?

Selecting an agent

It is not possible to know exactly what will happen in the future. However, appointing an agent gives that person the power to make health care decisions for you. These decisions will be based on what you have told your agent about your wishes, as well as the information in your directive. (An agent can also be called a proxy, medical proxy, health representative or agent, power of attorney for personal care, or substitute decision maker.)

It is best that the agent be someone who understands your values and beliefs, and will act in your best interest. People usually select a family member or a close friend. Make sure that person feels comfortable being an agent.

Generally speaking, people who have dementia retain the ability to name an agent well into their illness. However, as this is not always the case, planning ahead is always the better option.

For more information

BRITISH COLUMBIA

Ministry of Health
Look under SeniorsBC, and then Advance Care Planning
www.gov.bc.ca/health/

Public Guardian and Trustee of British Columbia
www.trustee.bc.ca General inquiries: 604-660-4444

Dial-A-Law
The Canadian Bar Association, British Columbia Branch provides a library of legal information prepared by lawyers. The public can listen for free over the phone. Vancouver, 604-687-4680, or toll free 1-800-565-5297
www.dialalaw.org

Legal Services Society, British Columbia
www.lss.bc.ca

ALBERTA

Advance Care Planning, Alberta Health Services
www.albertahealthservices.ca

Personal Directives, Alberta Human Services
humanservices.alberta.ca

Guardianship and Trusteeship,
Alberta Human Services
humanservices.alberta.ca/guardianship-trusteeship.html

Finding a Lawyer, The Law Society of Alberta
www.lawsociety.ab.ca

SASKATCHEWAN

The Health Care Directives & Substitute
Health Care Decision Makers Act
www.justice.gov.sk.ca

Advance Care Planning, Regina Qu’Appelle Health Region
www.rqhealth.ca/programs/ advanced_care_planning

Health Care Directives (booklet)
Saskatchewan Ministry of Justice and Attorney General
www.justice.gov.sk.ca/Health-Care-Directives-final.pdf

MANITOBA

Seniors and Healthy Aging Secretariat
www.gov.mb.ca/shas/index.html

Seniors Information Line, Winnipeg
204-945-6565 or toll free 1-800-665-6565

Health Care Directive (Living Will), Manitoba Health
www.gov.mb.ca/health/livingwill.html

The Public Trustee of Manitoba
Phone: Winnipeg, 204-945-2700 | Brandon, 204 726-7025
or toll free 1-800-282-8069, ext. 2700

ONTARIO

A Guide to Advance Care Planning, Ontario Seniors’ Secretariat
Read on-line or download a PDF version:
www.seniors.gov.on.ca/en/advancedcare
Phone: 1-888-910-1999

Advance Care Planning, Speak Up,
Canadian Hospice Palliative Care Association
www.advancecareplanning.ca

Provincial resources
www.advancecareplanning.ca/provincialresources

Enduring power of attorney

In the same way that you might need help with decisions about care, support with finances may also become necessary. You can choose a trusted family member or friend to be your attorney. This person would make decisions about financial matters or property on your behalf if you were living but unable to make decisions on your own.

An enduring power of attorney is not part of a personal directive. It is a separate legal document. If you have a significant estate, or if there is family disagreement, prepare this document with the help of a lawyer. In simpler situations, standard forms (templates) can be used.

Guardianship and trusteeship

Sometimes it happens that a person is no longer able to make independent decisions and there is no personal directive or enduring power of attorney in place. In this situation, guardianship and trusteeship come into play. Guardianship is for personal matters, and trusteeship for financial matters. These authorities must be obtained through the courts.

If families and caregivers need to make such arrangements, assistance is available from community agencies. When the person is in hospital or continuing care, home care and social workers can help. However, as this is a court-appointed process, it is still a significant task for the family. Avoid the situation by planning ahead, and setting up a personal directive and enduring power of attorney.

Capacity

What is capacity? Having capacity means understanding the information important to making a decision. As well, a person can appreciate the consequences of that decision. When should capacity be assessed? Generally, adults are assumed to have the capacity to make their own decisions. A capacity assessment is done only if there is reason to believe someone is not able to care for personal affairs.

A person can have capacity to make certain types of decisions, but not others. For instance, a diagnosis of dementia does not automatically mean a lack of capacity. A person with dementia may keep the ability to make personal decisions until well into the illness, but lose financial reasoning quite early, or vice versa. A doctor, psychologist, or health care provider trained in this area can assess capacity.

A personal directive allows you to plan for your future, and put your wishes for future health and personal care in writing. It also allows you to choose an agent who knows your wishes and would be your best advocate. Share your expectations, wishes and values about medical decisions, such as end-of-life care and where you would want to live, with your agent. When appropriate, share this with other family members too. While a lawyer can be involved in creating a personal directive, it is not required. For financial matters, establishing an enduring power of attorney is recommended.

Planning Ahead The reasoning behind advance care plans

Advance care plans / personal directives