Saskatoon RC Diocese

Advance Health Care Directives - A Good Resolution

Advance Health Care Directives - A Good Resoution

By Sandra Kary, Catholic Health Association of Saskatchewan

(originally published inThe Prairie Messenger)

Are you the kind of person that makes New Year’s resolutions? Me neither. I find it too easy to break promises to myself. Now, I recall one year, when our kids were really little, we challenged our friends (who also had young kids) to a race to see who could get their wills done first. The losers took the other couple out for supper. We won.

Did you know...

  • 86% of Canadians have not heard of advance care planning
  • less than half have had a discussion with a family member or friend about healthcare treatments if they were ill and unable to communicate
  • only 9% had ever spoken to a healthcare provider about their wishes for care
  • over 80% of Canadians do not have a written plan
  • only 46% have designated a Substitute Decision Maker – someone to speak on their behalf if they could not communicate
  • facts featured with the 'Speak Up' campaign, www.advancecareplanning.ca

I think we should change the whole resolution idea to New Year’s contests… now that’s more motivating! Here's a challenge for you (and a friend)... First one to do your Advance Health Care Directive wins! However, I realize you may need a bit of an education on this (especially if you want to win).

Confusion persists when it comes to advance care planning. Generally, advance care planning is an over-arching term that speaks to the reflection, research, and conversations that one might undertake to express their wishes should they lose capacity (the ability to make their own decisions) during an emergency, serious illness or at end-of-life. When planning, you may want to consider how you define medical interventions and pain relief, family support and spiritual or religious beliefs that might affect your care.  In addition, you may want to consider whether you would find aggressive measures burdensome or of little benefit at end of life.  Engaging with medical (and sometimes legal) professionals, your priest or pastor, and particularly, family members, is par for the course.

With this groundwork, you are ready to develop a written document - often referred to as ahealth care directive, advance directive or living will. There is no "official form" for this, and many versions and templates are available. (However, it should be noted that legislation does vary - and some provinces and territories require you to complete certain legal forms, and forms to identify your proxy.)

Proxy is often appointed on the same form as an Advance Directive is made.   Many people assume that if they have an Executor of their estate or Power of Attorney established, that this is all the same. You may want that, however, when considering medical decisions, you may choose to appoint a single, a number of single (or successive) proxies who can act independently, or a group of joint proxies who make health-related decisions.  In Saskatchewan, The Health Care Directives and Substitute Decision Makers Act (1997) articulates that any person, 18 years of age or older, with capacity, can be appointed as a proxy to make decisions on your behalf. If you don't create a directive, or appoint a proxy, the nearest relative becomes your substitute decision-maker (using a ranked priority list - spouse, adult son or daughter, etc.). 

As mentioned, advance directive forms vary, and some legal requirements vary according to province, but most directives generally focus on your wishes regarding medical interventions (such as CPR, surgery, mechanical life support, amputation, etc), treatments (pain relief, sedation, nutrition and hydration) and what would be preferred under various medical circumstances.  Again, discerning your wishes regarding such interventions can be assisted by conversations with people such as your doctor, lawyer, spiritual leader and family.

As a 'death-defying' culture, many of us are either too uncomfortable or too intimidated to work through the variety of scenarios that could play out in our technologically-advancing world.  Many of us, if we do think of our mortality, envision a peaceful death at home surrounded by family members. This, scenario, however, is becoming the exception, rather than the norm. Just like your Last Will and Testament provides direction and peace of mind to your family and loved ones to deal with your affairs and assets, an advance care directive provides direction and peace of mind to your family and loved ones as they navigate medical decisions during crisis or complexity when you are unable to make those choices for yourself.

It can't be stated strongly enough that an advance care directive is only referred to once you have lost capacity. Only when you are unable to make medical decisions for yourself will it be consulted. If that happens, be clear that your proxies or substitute decision makers are there to fulfill your wishes as you have outlined, they do not override your established wishes. They are there to uphold the spirit of your directive - to be your voice, should clarity be needed.

This written document, that is signed, dated and witnessed is a tool for YOU. Remember, you can amend it at any time - just remember to keep your loved ones and medical team informed of any changes.

On that note... let the contest, ahem, challenge begin!  If you are looking for a deadline date, may I suggest April 16th - National Advance Care Planning Day!

For more information/resources please contact:
www.advancecareplanning.ca  - a national site providing information, templates, and links to provincial-specific resources

Printed booklets (developed by Fr. Mark Miller) of A Faith-Based Advance Directive For Health Care: A Catholic Approach and An Advance Directive for Health Care Based on My Christian Faith are available for purchase ($5 plus shipping) from the Catholic Health Association of Saskatchewan. Contact 306-655-5330 orcath.health [at] sasktel.net to order.
 www.stpaulshospital.org Patient and Family Services> Ethics - a variety of Sask-based ACD templates, including downloadable pdf versions of the booklets listed above.

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