Here are some common questions about advance care planning:
1. What is Advance Care Planning?
Advance Care Planning is a process of reflection and communication, a time for you to reflect on your values and wishes, and to let others know your future health and personal care preferences in the event that a health practitioner determines you are not capable to either make and/or communicate your own healthcare choices. Advance Care Planning means having discussions with family and friends, especially your Proxy (if you have named one in a legally binding Health Care Directive), or with family and friends who may be called upon to be your Substitute Decision Maker (the person who will speak for you) if a Proxy has not been named in a Health Care Directive. It may also include preparing a written Advance Care Plan, creating a Health Care Directive, and may even involve talking with healthcare providers and financial and legal professionals.
2. What is the Advance Care Planning Workbook?
This free, interactive workbook consists of five steps to help you reflect on your values, wishes and preferences for future health care. You can move between the different sections as much as you like and fill out the questions in each section.
3. Why do I have to write it down – my family will know what to do?
Writing it down helps make sure your wishes are clear for everyone. You may believe that they know you well enough that they will know what to do; but perhaps they don’t. Maybe your values and beliefs have changed over time and are no longer consistent with the wishes I expressed in the past. Completing the Advance Care Plan Workbook helps identify your wishes and beliefs, as well as what you would consider acceptable with regard to your overall condition and treatment options.
You can use what you have written in this workbook as a guide for the conversations you will have with your family, Proxy and health care providers. For example, you may have said something like: “Pull the plug if a machine is all that’s keeping me alive.”; but you need to be clear about what that really means to you. Your family may also have questions about the choices that you’ve made.
4. What is the difference between an Advance Care Plan and a Health Care Directive?
An Advance Care Plan is a record of your health care preferences that is made while you are capable of providing consent to health care treatment. An Advance Care Plan does not provide authority for any treatment, nor does it authorize anyone to act as your Proxy. A Health Care Directive is a legal instrument, similar to a will or power of attorney that is made while you are capable of providing consent to health care treatment. In your Health Care Directive, you can appoint a Proxy and specify medical procedures for which you provide consent or refuse consent. A Health Care Directive comes into effect when you lose capacity to provide consent to health care treatment.
5. Will my wishes be followed?
The wishes expressed in a legally binding Health Care Directive must be followed, provided they are legal, realistically possible, and are consistent with the ethical standards of the health practitioner responsible for your care and treatment.
The wishes expressed in an Advance Care Plan are not legally binding. The information contained in your Advance Care Plan may be useful to you in creating your Health Care Directive, or serve to guide individuals called upon to made decisions about your care and treatment (your Proxy (if you have named one in your Health Care Directive) or Substitute Decision Maker (if a Proxy has not been appointed, or is not able or willing to act on your behalf)).
6. What is a Health Care Directive?
A Health Care Directive needs to be in writing, and be dated and signed in order to be valid. A Health Care Directive never takes priority over a capable person’s consent
Your Health Care Directive may be very detailed about what treatments you want or don’t want, or may be a general outline of your values, beliefs and wishes, without details. Your directive will guide your Proxy or Subsequent Decision Makers in the decisions to be made about your treatment when a health practitioner has determined that you’re not capable of doing this yourself.
7. What does a Health Care Directive include?
A Health Care Directive is a record of your current wishes. In any directive, you may include some or all of the following:
- your appointment of another person or persons as Proxy to make health care decisions for you when you cannot make or communicate them yourself;
- what treatments, procedures, or medications you want, don’t want, or would like to have stopped;
- when you would like to die a natural death and receive only the care necessary to reduce pain and suffering;
- your statement that specifies an event or circumstances when your Health Care Directive takes effect;
- any other instructions you have concerning your health care or treatment.
You do not have to include all of these areas. You can use the directive to name a proxy only. You don’t have to outline details of your wishes about treatment. You can’t direct anyone to do anything illegal or unethical.
Your directive may be very detailed about what treatments you want or don’t want. Your directive may be a general outline of your beliefs and wishes, without details. Your directive will guide your Proxy and others in the decisions to be made about your treatment when you’re not capable of doing this yourself.
Remember that you can change your Health Care Directive at any time. If you make any changes to your Health Care Directive, it is your responsibility to destroy your old copies, inform anyone you’ve given copies to that you have made changes, and provide them with copies of the updated document, requesting that they also destroy any old copies.
8. I already have a Health Care Directive ‒ isn’t that good enough?
Having an Advance Care Plan in addition to a Health Care Directive, can aid in having conversations about your values, beliefs and wishes with key individuals and loved ones. It will help those called upon to make the best decisions for you when you can’t make decisions or speak for yourself.
9. What if I don’t have a Proxy or my Proxy is not able or willing to make decisions for me?
If you don’t have a Proxy or your Proxy is not able or willing to make decisions for you, a Substitute Decision Maker will be appointed in accordance with the provisions of the Consent to Treatment and Health Care Directives Act. The following is a list, in order of priority, of individuals who would qualify to be your Substitute Decision Maker as specified in the Consent to Treatment and Health Care Directives Act.
- the Proxy (if one has been appointed);
- the guardian, if having the authority to give or refuse consent to treatment;
- the spouse;
- the son or daughter, or the parent, or a person who has assumed parental authority and who is lawfully entitled to give or refuse consent to treatment on the patient’s behalf;
- the brother or sister;
- a person whom the health practitioner considers to be the patient’s trusted friend with close knowledge of the wishes;
- any other relative of the patient.
10. Do I need to have a Health Care Directive as part of my Advance Care Plan?
However, you may wish to have a Health Care Directive to appoint someone to act as your Proxy to make health care decisions on your behalf in the event that a health practitioner determines that you are not capable of providing or refusing your consent for health care treatment. You can also use a Health Care Directive to direct your Proxy with respect to the types of treatment that you would consent or refuse to consent to, and in what circumstances.
11. What does capable mean?
- to understand the information that is relevant to making a decision concerning the treatment;
- to understand the information that applies to his or her particular situation;
- to understand that the person has a right to make a decision; and
- to appreciate the reasonably foreseeable consequences of a decision or lack of decision.
Capable means that you are able to understand the information relevant to making a decision about treatment and to appreciate the consequences of that decision. Capacity can fluctuate – you may be not capable at one time and capable at another; or not capable of making some treatment decisions yet capable of other treatment decisions.
It might be helpful for you to speak with someone you trust, such as family, friends or primary health care provider, etc. Completing the Advance Care Plan Workbook may assist you in determining your values, beliefs and wishes that you may want to include in your formal Health Care Directive. You may want to enlist the assistance of the person you will list as your Proxy in your Health Care Directive so that they will have a better understanding of your values and beliefs.
12. What if I change my mind?
Life changes, and so may your wishes for your future health care and treatment. Make sure you regularly review your Advance Care Plan and your Health Care Directive, and make sure that your Proxy (if you still want him/her to be your Proxy) is still willing and able to make decisions for you if you cannot speak for yourself. If you make any changes to your Health Care Directive, it is your responsibility to destroy your old copies, inform anyone you’ve given copies to that you have made changes, and provide them with copies of the updated Advance Care Plan and/or Health Care Directive, requesting that they also destroy any old copies in their possession.
13. These types of documents are only for old people or people who are sick, right?
No. You can’t predict how and when you may become incapable of making health care decisions for yourself, either due to illness or as the result of an accident. If you are 16 or older, you should discuss and take part in Advance Care Planning. Having an Advance Care Plan and Health Care Directive, and having conversations about your values, beliefs and wishes with key individuals will help those called upon to make the best decisions for you when you can’t make decisions or speak for yourself. You can change your plan as often as you like, and as your life changes.