There is no such
thing as a living will in BC. It is a concept imported from the United States. There
may be the ability to have a living will in your jurisdiction, so before
assuming that you can do this check with a legal expert. However, where I live
in British Columbia we have legislation that allows individuals to express
their wishes, usually in writing, regarding the care they want to receive or
reject. What I am encouraging is that people have a conversation
with their families or friends to discuss what should be done if, and only if,
they are unable to speak for themselves
Advance care planning
(ACP) begins with an in-depth discussion about your values, wishes, and
beliefs. Pay particular attention to the topics that should be included in the
discussion of your values, your wishes and your beliefs. The subject should be
revisited from time to time because people’s views can change depending on a
variety of circumstances: health concerns, new medical procedures, new
relationships. Think of your advance care planning as an organic process, as
you grow your wishes, thoughts change.
Remember in most
areas and in all of Canada a written Advance Care Plan is not a legal document
but it is a powerful document because decision makers will have guidelines to
follow should they be placed in a position of speaking for another person who
is incapable of speaking for him or herself. The plan is acted upon when, and
only when, you are incapable of making your own decisions.
The assumption the
law takes is that most capable adults want to make their own decisions about
their medical care. Under the law a health care provider must presume an adult
is capable of making a decision until it is demonstrated that the person is not
capable.
Sometimes it is not
easy to prove that a person is incapable of making his or her own decisions.
For example if a person is unconscious it is easier to determine incapability
than if they are slow to speak or difficult to understand, perhaps because of a
stroke or the effects of medication. However, if you cannot speak for yourself
then somebody else will have to make decisions about your medical and
end-of-life care
These are the tests
that help medical caregivers to determine whether the individual who must be 19
years of age or older can make his or her own decisions. The first assumption
must be that the adult is capable, which means that he or she demonstrates the
following:
- Understands the information
being given about his or her health condition;
- Understands the nature of
the proposed health care, including the risks, benefits and alternatives;
and
- Understands that the
information applies to his or her own situation.
If you are
accompanying such an individual, perhaps in an emergency department, then you
may need to intervene if you think the medical caregiver is rushing this
procedure. This is a crucial moment in the care process.
The real impact of
advance care planning and the components that drive the subsequent care is that
Decisions are going to be made, and that you can make them. or you can decide
who will make them if you cannot. The most important idea is that: COME WHAT
MAY, DECISIONS ARE GOING TO BE MADE.
That is why it is
very important to have a Representation Agreement and you need to be sure that
the representative (s) named know what your wishes are. The Advanced Care
Plan (ACP) is not the same as a Representation Agreement. A Representation
Agreement indicates who you want to speak for you when you are not capable of
speaking for yourself. It is a legal document that sets out the kinds of
decisions the representative may make.
An ACP provides
information about the care you want to receive. It works hand in hand
with a Representation Agreement
The importance of
having the right person involved requires legal documentation or in BC the
Temporary Substitute Decision Makers list will be used. Who is on the Temporary
Substitute Decision Makers list in BC (this may be different in your area:
Spouse: married or cohabiting; may be same sex, Child (no specific order if
more than one), Parent (so specific order), Sibling (no specific order if more
than one), Grandparent (no specific order), Grandchild (no specific order),
Anyone else related by birth or adoption, Close friend, and finally In-law (no
specific order)
Decisions will be
made, and if you cannot make them one of the above will, but you can give this
power to someone you trust to look after your best interests. So when you start
this search, here are some questions to consider
- WHO do you approach to start
the conversation?
- HOW would you start?
- WHAT are your values, wishes
and beliefs?
- WHERE will the plan be kept?
These suggestions
about how to start the conversation may apply to the person expressing his or
her own values, wishes and beliefs or by a concerned family member or friend
who might be placed in a position of making the decisions.
This can be a very
tricky part of the process because very unpleasant occurrences are being
contemplated, otherwise the patient would be making his or her own decisions.
Deep emotions may surface and the parties involved need to structure the
discussion carefully with regards to site, attendance, calling a recess,
compilation of the written record, etc.
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