- It is a legal document dated, signed and witnessed.
- It is used when the adult is not capable of giving instructions at the time the health care is required.
- Representation Agreement is a legal document that names the person or persons who will speak for you if you are incapable of speaking for yourself.
- Advance Care Plan (May be oral or written (preferable). It is not a legal document in my Province (it may be legal in yours--check with your legal team). It sets out the wishes of an individual with regard to the kind of care and treatments he or she wants to have. It can include end-of-life care.
- Advance Directive (AD) is a written legal document that is to be given to health care providers to guide them in providing care when the patient is unable to speak for him or herself.
- Power of Attorney – This document does not deal with health care. It deals with financial and legal matters.
- When a Personal Guardian (Committee of the Person) appointed by the Supreme Court disagrees.
- When the AD does not deal with the health care decision at issue.
- When it is unclear what the adult wanted.
- When it is in conflict with the patient`s known wishes, values or beliefs.
- When changes in medical knowledge, practice or technology might substantially benefit the patient, unless it states that it applies regardless
Example: The Advance Directive (AD) states that the patient does not want to be attached to machines. What exactly does that mean? Some ‘machines’ such as an IV drip are quite routine and others are very sophisticated.
The medical team will do their best to follow your AD, however they can only follow it if it is clearly written. That is why specific language must be very carefully considered. For example saying “I do not want to be resuscitated if my representative is satisfied that my illness is terminal and I am expected to die within the next six months.” is not a directive. It is a statement that expresses a preference but not a specific instruction. It would require interpretation and judgement and cannot stand alone.
Consent is required for all types of health care with two exceptions:
- Preliminary examination, treatment or diagnosis if the patient has indicated that he or she wants the health care; and
- Urgent or emergency health care that is necessary to preserve life, prevent serious physical or mental harm or to alleviate severe pain.
- When the patient is stabilized then the rules of consent apply.
Remember: Decisions are going to be made by somebody. This is why a Representation Agreement is strongly advised. Perhaps the patient does not want his or her spouse to be put in the position of making life or death decisions, or the patient has several children and has definite ideas about who should represent him or her. Without a Representation Agreement, the medical personnel will use whichever child they can reach first.
Source: The information from the last two posts on Advanced Care Planning and Advance Directives come from various sources including MyVoice Booklet and COSCO Health and Wellness Workshop on Advanced Care Planning