Your guide to advance care planning

This article was co-written by Lisa Wattam and Courtney Johnson, Family Health Nurses

 

Advance care planning is the process of thinking about and discussing your values and goals towards healthcare with your loved ones. Although it is similar, it is NOT an advanced directive or living will. The focus of advance care planning is not on document creation, but on discussion and communication with your loved ones.

Why is it important?

Advance care planning is important to ensure your loved ones are aware of your values and goals if a situation should arise when you are unable to make decisions on your own. Advance care planning helps end of life decisions by:

  • Ensuring quality of life
  • Reducing the use of non-beneficial medical care near death
  • Ensuring care is more aligned with your values and goals
  • Improving family outcomes (reduces the stress of decision making about end of life care)

Steps to get started

  1. Think! About what is right and important for you when it comes to your health
  2. Learn! About the different medical procedures or therapies offered to you. There may be some you would like to receive and others you may not
  3. Decide! Who will be your “substitute decision maker”? A loved one who is able to speak for you and honor your wishes if you can’t speak for yourself
  4. Talk! About your wishes and decisions with your substitute decision maker, loved ones and healthcare professional
  5. Record! Your beliefs, values and wishes. You can write them down, record them or make a video

Who you can talk to at Copeman?

The nurses may bring up the topic if you are new to the clinic and having your initial intake. Otherwise, you may reach out to many team members, including your nurse, nurse practitioner or physician. We will be able to help you get started and thinking about your values.

Advance care planning FAQ’s

1. What is the difference between an advance care plan and an advance directive?

An advance directive is a legally binding document that provides the adult’s written instructions, made while capable, directly to their healthcare provider, for the care they wish to consent to or refuse when incapable. An advance care plan may include a representation agreement and/or an advance directive, both of which are optional. An advance care plan that does not include a representation agreement or an advance directive informs the person chosen by a healthcare provider to make care decisions for the adult based on the adult’s instructions or wishes expressed while capable. That person is called a temporary substitute decision maker.

2. What is the difference between a living will and an advance directive?

The term ‘living will’ is a term from the United States that has been adopted into everyday language, and typically refers to any kind of advance care planning document. The term ’living will’ is not in B.C.’s health care consent legislation, although it is generally accepted to mean a person’s wishes for future healthcare.

3. What is a temporary substitute decision maker (TSDM)? How is a TSDM chosen?

A TSDM is a capable adult over the age of 19 who is chosen by a healthcare provider to give or refuse consent on an adult’s behalf when an adult is incapable of making a decision when the healthcare decision is needed. A TSDM may decide about any type of healthcare treatment except for those on the prescribed list in the Health Care Consent Regulation. A TSDM is usually a close family member and is chosen from a list that a healthcare provider must follow.

1) The adult’s spouse (may be married or cohabiting; may be same sex);

2) The adult’s child (any, equally ranked);

3) The adult’s parent (equally ranked and includes adoptive);

4) The adult’s brother or sister (any, equally ranked);

5) The adult’s grandparent (any, equally ranked);

6) The adult’s grandchild (any, equally ranked);

7) Anyone else related by birth or adoption to the adult;

8) A close friend of the adult;

9) A person immediately related to the adult by marriage.

To qualify as TSDM, a person must:

1) Be at least 19 years of age;

2) Have been in contact with the adult during the preceding 12 months;

3) Have no dispute with the adult;

4) Be capable of giving, refusing or revoking substitute consent; and

5) Be willing to comply with the duties of a TSDM.

If a qualified and available TSDM cannot be identified to make a decision on the adult’s behalf, the Public Guardian and Trustee (PGT) may authorize someone, including a person from the office of the PGT, to be chosen as a TSDM. If an adult has a court-appointed personal guardian (committee of the person) or has named a representative in a representation agreement, a TSDM is not chosen unless the committee of the person or representative is incapable or unavailable.

4. Can I choose my TSDM?

No. Your healthcare provider chooses a TSDM (using the list above) when you are incapable and a healthcare decision is needed. If you want to specify an adult as your substitute decision maker instead of your healthcare provider choosing a TSDM, you must name a representative in a representation agreement while you are capable of doing so.

Resources

Speak up Canada: Advance care planning workbooks and quick guides

Alberta Health Services Advance Care Planning

BC Government Advance Care Planning