Advance care planning

What is Advance Care Planning?

Advance Care Planning (ACP) helps ensure that your loved ones know what kind of health care you would want if you were sick and unable to speak for yourself. This includes thinking about your health care wishes and who you trust to make decisions about your health care. ACP also involves talking about your wishes with the person you would want as your substitute decision maker, with your loved ones and with your health care providers. ACP may also involve recording your wishes, creating a legal document, and sharing your plan.

Life can be unpredictable. We can be healthy one day and face an accident or illness the next. If you can't speak for yourself, someone else will have to decide what medical treatments you get. By planning ahead, you:
- Make your health care wishes clear.
- Give guidance to your health care team.
- Make things easier for your loved ones during tough times.
Advance care plans may be as simple as having a conversation with the person who would act as your substitute decision-maker if you were sick and could not speak for yourself. This conversation would help that person understand the types of decisions you would want them to make for you.

Or, an advance care plan could be one of the following documents:

A Representation Agreement is an advance care planning document where your substitute decision maker is formally and legally appointed to you.

An Advance Directive is another type of advance care planning document in which you write legally binding directions to the health care provider. These directions would be used if you become sick and cannot speak for yourself. In BC, Advance Directive documents are best for people with strong wishes that are unlikely to change. An example is not wanting a blood transfusion under any circumstances.
Suppose you are admitted to the hospital and cannot speak for yourself. If you have not asked someone to be your health care decision maker and do not have a Representation Agreement, a Temporary Substitute Decision Maker (TSDM) will be appointed for you. A TSDM is a requirement under B.C.’s Health Care Consent Act.

Your health care provider is responsible for appointing a Temporary Substitute Decision Maker (TDSM). The health care provider appoints the first person on the list below who is willing, able and qualified to be a TSDM:
- Your spouse (including common-law, same-sex)
- A son or daughter
- A parent
- A brother or sister
- A grandparent
- A grandchild
- Anyone else related to you by birth or adoption
- A close friend
- A person immediately related to you by marriage (in-laws, etc.)
- Public Guardian and Trustee (PGT)
If you want to be certain about the person you want as your Substitute Decision Maker, make a Representation Agreement while you are able.

Remember, conversations with our loved ones and health care providers are at the centre of advance care planning. These conversations should include things like:

What would matter most to me if I became unwell and couldn’t communicate;
What my goals would be and what I might be afraid of;
What I would be willing to go through in the way of treatment, hospitalizations, living in a long-term care home, etc, for the possibility of living longer;
What medical treatments would be acceptable to me, and what would not be acceptable; and Who I would want to make decisions for me.

While planning your future health care needs, you might also consider appointing someone to make financial and legal decisions for you through an enduring power of attorney, and a Will for your estate planning. Click on Wills and Estate Planning for details.

Contact: Wallace A. Robinson MSW RSW
Leader for Advance Care Planning, Providence Health Care

Email wrobinson@providencehealth.bc.ca

What should I know about Representation Agreements and Advance Directives?

A Representation Agreement (RA) is a legal document created by a capable adult to appoint a Representative to act a substitute decision maker in the event of an adult's incapability. A Representation Agreement may be created with or without a lawyer or notary public, and is signed by two witnesses (or one witness who is a lawyer or notary). There are 2 types of Representation Agreements in BC:
1. A Representation Agreement 'Section 9' or 'Enhanced' is intended for a capable adult to name the person they wish to act as their health and personal care representative if they become unable to make their own health care decisions.
2. A Representation Agreement 'Section 7' or 'Standard' is an option for an adult with lower levels of capability, such as a person with a cognitive impairment or early dementia. An adult creating a ‘Section 7’ Representation Agreement may not meet a legal definition of capability, but they can identify who they trust to make health care decisions for them.
An Advance Directive is a document providing legally binding instructions directly to the health care provider by a capable adult for the health care to which they consent or refuse. An advance directive may be written on a Ministry of Health Form (available in the My Voice guide, linked below) or may be created by a lawyer or notary public. An Advance Directive must be signed by two witnesses (or just one witness if the witness is a lawyer or notary public).

What is Advance Care Planning?

Information and resources

What should I know about Representation Agreements and Advance Directives?