COVID-19 highlighted the challenges in our health care and long-term care systems in this province.
It was a wake-up call. Stress levels were high.
Health Care practitioners were having to care for critically ill patients with no direction from the patient or the family as to what their wishes were.
It highlights how important Advance Care Planning is.
Advance Care Planning (ACP) is about 2 important steps each of us can take:
1. Making choices now while you are still capable about how you wish to be cared for in the future if you become incapable of making decisions.
2. Giving someone you trust the information and authority to act on those wishes for you.
Each of us hopes to maintain our capacity to make decisions for ourselves. As we age this is sometimes not going to be the case.
Incapacity is defined as not being able to understand information that is relevant to making a decision concerning one’s own health care, nutrition, shelter, clothing, hygiene or safety, or is not able to appreciate the reasonably foreseeable consequences of a decision or lack of decision. There are 3 possible parts.
In Ontario, capacity is presumed under the Substitute Decisions Act. This means that before a person’s right to make decisions for him/herself is removed it must be proven that they do not have capacity.
Often it is a doctor or other trained medical professional who makes decisions about an individual’s capacity and those decisions can be appealed.
If an individual is declared to not have capacity, then the health care professionals will turn to the patient’s substitute decision maker (SDM) to make key decisions.
The legislation sets out a hierarchy as to who can make health care decisions and often it is a family member. Health care professionals work through the hierarchy until an individual is identified.
The government through the Office of the Public Guardian only steps in when there is no one else able or available to act.
So Advanced Care Planning is choosing one’s Substitute Decision Maker (SDM) and reviewing your wishes with them. The best way to formally appoint a SDM is through the Power of Attorney for Personal Care.
Making that appointment now provides you with an opportunity to make choices about your future personal care. It can give you peace of mind. It can make it easier for family and friends as it reduces the stress of them trying to make decisions often in times of crisis.
It’s also easier for health care providers because they’ll be able to act knowing what your wishes are.
What choices can you make with ACP?
You can decide where you want to live.
What you want to eat.
What kind of health care you want.
Health care providers are required to take direction from the person who is empowered with Power of Attorney for Personal Care.
Your Power of Attorney (POA) must follow your expressed wishes wherever possible and act in your best interests.
So, it’s important to select someone who you trust, and whose judgment you trust. Often this is a family member. Other factors to consider include the age of the Power of Attorney and where they live.
Technically speaking the Power of Attorney is the legal document through you which you appoint a SDM. But in daily use most people refer to a person as the Power of Attorney.
It’s also important to ensure the legal document is provided to your POA and to appoint a back up person as Power of Attorney.
The steps involved in Advance Care Planning include:
Thinking about your values and what personal care you would want or NOT want.
Consult friends, family and advisors who can provide information about your options.
Decide upon and appoint your SDM
Write it all down with detailed instructions through a Power of Attorney drafted by a lawyer.
If your wishes change then be sure to revise your POA in writing.
Remember your Power of Attorney for Personal Care can only act for you when you are unable to make decisions for yourself.
If you require assistance and support while you still have full decision-making capacity, then you might want to consider working with an experienced Care Planning professional.