Most people want some control over their end-of-life decisions and care. However, sometimes health issues can arise where they cannot make these decisions independently. Without input, it can be difficult for families to make decisions that align with a loved one’s wishes. However, there's a solution if you plan ahead. An Advance Care Directive provides a way for individuals to ensure their wishes and values are acknowledged and respected after death. Here is what you need to know.
An advance care directive is a legal document that can provide instructions for future medical care or to define end-of-life choices that can be used by a family if their loved one is incapable of physically or mentally advocating for themselves.
There are generally two types of advance care directives used in Canada.
The first option involves choosing a designated person to make end-of-life decisions on your behalf. This individual is referred to as a health care proxy or substitute decision-maker. It is someone that is appointed to make health and medical decisions at a time when you cannot make them for yourself. A substitute decision-maker is automatically designated by law if a health care proxy has not been chosen or if an Advance Care Directive has not been made beforehand. The role typically falls to the next of kin and is usually a spouse, a parent, an adult child, or siblings.
The other common type of advance care directive provides instructions on specific health care decisions (e.g., do not resuscitate) or describes values and beliefs to help guide a decision-maker.
Regardless of the option chosen, the individual is the only one that can make the Advance Care Directive for themselves. They must also be competent at the time it is made and are capable of critical decisions for themselves. Since no one can plan for a sudden illness or injury, it is best to make a directive while healthy.
In Canada, each province has legislation that gives legal force and effect to these documents. However, advance care directives are generally viewed as legally valid across Canada, and doctors are expected to honour them.
Advance care directives may also be called:
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Creating an advance care directive gives a person the final say in personal, medical, and end-of-life decisions. It can provide peace of mind knowing that wishes and values relating to health care or quality of life are known, understood, and will be respected by family and healthcare professionals.
It also relieves a family from the responsibility of making tough decisions. People can hold differing opinions on the best option when a loved one becomes incapacitated due to an illness or injury. For some families, it can be challenging to agree on a strategy. Disagreements and arguments can escalate, resulting in legal disputes. Additionally, certain decisions may be time-sensitive, and a failure to agree on a strategy can prolong decision-making to the point that it affects the outcome. Not all relatives will have the individual’s best interests in mind. An Advance Care Directive eliminates this guesswork and the potential burden on a family.
An advance directive can provide instructions orally or in written format. However, a written document is easier to verify. If instructions are given orally, there is no guarantee that they will be honoured, especially if only one person has been notified.
Advance Care Directive forms are easy to produce, and many companies and lawyers provide templates. However, it is crucial to get educated on the options and choices before signing a care directive. It is also important to review personal beliefs and values and translate them into medical and end-of-life decisions. It can be helpful to include family (and friends, where applicable) in this discussion, but the final decisions are at the discretion of the individual making the Advance Care Directive. It is also good practice to review the document (and make changes, as needed) every couple of years.
Advance Care Directive forms vary slightly depending on the type of directive chosen and which provincial regulation is applicable. However, standard information and requirements include:
Below, we have outlined requirements and examples for advance care directive forms in Ontario and Nova Scotia, where Eirene is licensed to conduct end-of-life arrangements.
In Ontario, there is no legislation related explicitly to advance directives. The term typically used is “wishes.” If a person expresses their wishes in an advance directive or power of attorney for personal care document, it will be honoured. It can be done in writing, orally, or otherwise.
An Advance Care Directive is a form outlining one’s wishes and desired treatments. Health care professionals are expected to follow the wishes in the document. If there is a decision not outlined in the document, they must follow the wishes of the substitute decision-maker or power of attorney for personal care. This form does not require a witness, but it is recommended. Copies must be signed and distributed. If not, there is a risk that the advance directive will not reach a healthcare professional or substitute decision-maker.
A Power of Attorney for Personal Care is a legal document that gives someone the power to make personal care decisions on your behalf. This document requires two witnesses for your signature. This witness must not be the individual appointed as power of attorney, spouse, child, or under 18 years old. It is advised to use a lawyer or notary public to help with these forms or to notarize them. Otherwise, some authorities may not accept the document. Original copies and any changes must be witnessed and signed correctly, or they could become invalid. It is also advised to keep signed originals and a few copies for yourself and the substitute decision-maker and give them to health care providers.
An example of this form (in PDF format) can be downloaded here: Advance Care Directive/Wishes for Ontario residents.
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In Nova Scotia, advance directives are called personal directives. Individuals can provide preferences or appoint a substitute decision-maker (called a "delegate") but must choose only one option.
Like the Power of Attorney for Personal Care, the delegate is appointed to make medical and health care decisions on your behalf. Otherwise, instructions can be provided and followed by a healthcare provider.
The Personal Directive form must be witnessed by one adult, which cannot be the delegate or spouse of the delegate. The form can be signed on your behalf, but the person signing cannot be the delegate, spouse of the delegate, or witness. The form should be on file in your medical records or in an easy-to-find location (e.g., on the fridge). Again, changes must be signed and witnessed correctly to ensure it is valid.
An example of this form (in PDF format) can be downloaded here: Personal Directive for Nova Scotia residents.
If you need a personal directive form for other provinces or territories in Canada, they are listed and available for download on the Dying With Dignity website.
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