" ... The people I met, both participants
and trainers, were wonderful. We listened, we shared, we learned
and came away with a deeper understanding of the events and
issues accompanying the process of dying, death, and, for surviving
family and friends, loss, grief, and recovery..."
~ R.H.
Medical Pre-planning
Any adult can benefit from the peace-of-mind
that can result from planning for a possible time when they are
no longer able to direct their own medical care. This is especially
true for people who have been diagnosed with a life-threatening
or terminal illness and for people in their senior years.
Doing medical pre-planning can ensure your wishes are
followed and alleviate stress for family members and prevent unnecessary
family suffering and conflict.
Physicians and other health care professionals also benefit from knowing that
they are acting in accordance with your wishes.
In British Columbia, the Representation Agreement Act, which came into effect
in 2000, is a mechanism by which adults can name a Representative to make decisions
for them, if, by reason of injury or disease, they are no longer able to make their
own decisions. The person (or persons) designated can make legal, financial,
personal care and medical decisions. This Act also states that the Representative(s)
must make the decisions in accordance with the person's expressed wishes and
instructions.
If there is no Representation Agreement, the Health Care Consent Act names the
next-of-kin as a substitute decision maker for people who are not able to give
or withhold consent to medical treatment. This legislation also states that decisions
made by the substitute decision maker have to be in accordance with the person's
expressed wishes and instructions.
In situations where conflict between various family members is possible, or if
your next-of-kin does not share your values and beliefs, it is more crucial that
you do the necessary pre-planning to address your needs.
It is important for people to consider what treatments
they might or might not want under various medical situations should they not be able to direct their own care.
Such instructions are known as
advance medical directives or "living
wills" -- you are making medical choices in advance that only have
relevance while you are still living. To address this issue, gather
information, consider the options and discuss your thoughts with your family
physician, your family or others close to you.
In British Columbia, Do Not Resuscitate orders (DNRs) are a type of advance directive
indicating that you do not want cardiopulmonary resuscitation to be done
if you stop breathing or if your heart stops beating. People who have a terminal
illness or are at the natural end of their life can make this request. This should
be done after discussions with your doctor as the form needs to be signed by
your doctor. It is important to remember that this document applies only to cardiopulmonary
resuscitation and not other types of treatment.
Although BC Legislation says that your wishes, whether verbal or written, must
be followed, you have much better protection if your wishes are written. It is
also important for all the people close to you and your doctor(s) to know that
you have written an advance directive and for them to have a copy or know how
to find it. Your wishes can only be followed if people know them. Do NOT put
your advance directive in a safety deposit box as it may not be accessible when
it is needed.
Currently there is no standardized advance directive form to use and some types
that exist are not very useful because they are unclear and/or incomplete. Nelson
& District Hospice and other Hospice organizations can provide you with
printed information as well as sample advance directives you can consider using
or adapting to fit your own wishes. This example of an Advanced Directive will give you som idea.
If you make a Representation Agreement, you may have your advance medical directive
as part of the Agreement or as a separate document you would attach to it.
It is also important to remember that these documents are a form of "insurance" and
may never come into effect. If you remain able to direct your own affairs
and give or withhold consent to medical treatment, they will never have to be used.
Having them in place, however, provides you, your family or loved ones
with peace-of-mind should the need ever arise.
