Advance Care Planning

Advance Care Planning is the process of considering and documenting your directions for future health care in the event that you are unable to speak for yourself. In making an Advance Care Plan, it is important to document your directions according to your values and principles and then express them to your family, friends, Substitute Decision-Maker(s) and health care providers. 

Advance Care Planning allows you to maintain control of your personal health care, allowing you to direct both the treatments that you might want to receive, but also treatments you might not want to receive. The more detailed an Advance Care Plan is, the better it is for your Substitute Decision-Maker(s), your loved ones, your family, and your health care providers.

An Advance Directive is not the same thing as an advance request for MAID. The current laws of Canada do not allow you to request MAID in advance. Your Substitute Decision-Maker(s) cannot consent to MAID on your behalf. You are welcome to include directions regarding MAID in your Advance Directive, but your wishes around MAID cannot be acted upon unless advance requests for MAID become legal.

Advance Care Plans are not written in stone. Your needs, values, and preferences may change over time and it is important to update your Advance Care Plan regularly. We generally advise people to review and revise their Advance Care Plan every three years, and to update anyone involved in your care, including your Substitute Decision-Maker(s). 

Health Care providers should be allies in a patient’s Advance Care Planning process. They can help with the wording, knowledge, and information necessary to be able to make informed decisions about future health care. 

A Substitute Decision-Maker is the person to whom your health care provider would turn for direction in the event that you were incapable of making decisions for yourself. Ideally, they would be someone who knows you well and whom you trust, because they will be making decisions based on the values and principles you have expressed to them. 

In most jurisdictions across Canada, if you do not have a Substitute Decision-Maker, you will be assigned one. For example, the province or territory may go down a list, starting with a spouse or partner, to one’s adult children, one’s parents, a brother or sister, close friend or personal advisor, and in the event that no one is available, the public guardian and trustee. 

It’s never too early to start Advance Care Planning or to think about end-of-life care wishes. Some people think that Advance Care Planning is only for people who are elderly or approaching death, but all people, regardless of their age, are encouraged to appoint a Substitute Decision-Maker and create an Advance Directive so their wishes are known. 

Consider how you like to spend your free time, what is most important to you, what you fear the most about your end of life, how healthy or frail you are at this point in time, and how you imagine your final days unfolding. 

It is recommended that you be as direct as possible. Approach your health care provider and say, “I want to speak with you about my end-of-life care and my end-of-life wishes. I would like you to keep a document in your files and would like my wishes to be respected in the event that I am no longer able to speak for myself.” 

Each province and territory has its own legislation when it comes to Advance Care Planning. In an emergency, if your Substitute Decision-Maker(s) is/are unavailable and your Advance Care Plan is not readily accessible, the clinicians treating you will make decisions based on their knowledge of you or what is considered best practice for your condition. 

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