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Advance Care Planning in BC Explained

In this article:

    Without an advance care plan, decisions about your medical care may be made by someone who doesn’t know you or your health care and end-of-life wishes. 

    When you have an advance care plan, your loved ones won't have to make tough decisions by themselves.

    Your advance care plan can also include a Representation Agreement, which allows you to choose a representative to make health decisions for you if you can’t. If you don’t have an appointed representative, your temporary substitute decision-maker will be asked to make decisions for you. 

    In this article, we’ll go over what advance planning is, how medical decision-making in BC works, what personal planning tools are available to document your future healthcare wishes, and what the legal aspects of BC healthcare planning are. 

    Key Takeaways

    • An advance care plan is important for every adult, no matter what your current health status is, and can include an advance directive, a Representation Agreement, and more
    • An advance directive is where you document your beliefs, values, wishes, and instructions for health care should you be unable to communicate
    • A Representation Agreement appoints a representative to make health and personal care decisions for you if you ever become incapable of making them yourself
    • An enduring power of attorney is not always part of an advance care plan but can help you by appointing someone to make decisions on your behalf about your financial affairs, business and property

    Introduction to advance care planning in BC

    In BC, advance care planning is the process of thinking, documenting, and communicating your health care treatment wishes and end-of-life care instructions in the event you become incapable of deciding for yourself. 

    An advanced care plan is a legal form that documents your wishes for the type of medical care you want to have if you're badly hurt, have a serious illness, or are unable to communicate your wishes yourself. 

    Inside an advance care plan, you can also appoint someone as your decision-maker. This person will be called in to make healthcare decisions for you if you can’t. They can also be referred to as a substitute decision-maker or a healthcare representative, agent, or proxy.

    Who should fill out an advance care plan?

    Advance care planning is important for every adult, no matter what your current health status is. Regardless of your age, it’s really never too early to start an advanced care plan.  

    In the event something happens that leaves you unable to care for yourself, your healthcare wishes will be legally documented, which helps your loved ones honour your wishes and avoid making difficult decisions.

    According to BC legislation, any adult can legally make an advance care plan and appoint representatives and attorneys. 

    The only exception is if the adult cannot understand the nature and consequences of the proposed documents, such as if they lack all relevant information, if they are under the influence of mind-altering substances, or if they suffer cognitive impairment due to Alzheimer's, dementia, or another condition. 

    Understanding legal frameworks

    Within your advance care plan, there are two forms you can complete to legally document your wishes and appoint people responsible for honouring them: an advance directive and a Representation Agreement. We’ll also explain the difference between these documents and an enduring power of attorney.

    ✏️ Make your decisions matter. Create your advance care plan in BC today →

    What is an advanced directive in BC?

    British Columbia health directives contain your beliefs, values, and wishes, as well as your instructions for health care given to your care provider. It must be legally honoured in the event that you cannot communicate your wishes yourself. If your care instructions are outlined in your advance directive, no one will be asked to make decisions for you. 

    If a decision needs to be made about something you haven’t considered in your advance directive, someone else will need to make the decision for you. This is where your representative or temporary substitute decision-maker comes in. 

    What is a Representation Agreement in BC?

    In a healthcare Representation Agreement, you appoint someone to make your health and personal care decisions if you ever become incapable of making them yourself. There are two types of forms for Representation Agreements.

    The Section 9 type of Representation Agreement allows your named representative to take any step that they consider necessary in relation to your personal care or health care. Under this agreement, your representative can accept or refuse life support or life-prolonging treatment for you.

    The Section 7 type of Representation Agreement allows your named representative to help you make decisions, or make decisions on your behalf, with respect to personal care and health care, the routine management of financial affairs and obtaining legal services for the adult and instructing counsel. Under this agreement, your representative cannot refuse life support or life-prolonging treatment for you.

    Note: You can also name a Monitor in your Representation Agreement. A Monitor is responsible for making sure a representative is complying with their duties based on both your instructions and the Representation Agreement Act.

    What is an enduring power of attorney in BC?

    A BC enduring power of attorney is a document where you legally appoint someone as your attorney to make decisions on your behalf about your financial affairs, business and property. While this document is an important part of your estate plan, it is not part of your advance care directive.

    Documenting your healthcare wishes

    There are some important things to consider when creating your advance care plan, which we’ll cover in the following four steps:

    What are the four steps to advance care planning?

    1. Reflect on your values, beliefs and wishes. These are things you can document in your advance directive forms for your loved ones and healthcare providers to follow. Here are a few questions to guide you:
    • What things make your life meaningful?
    • When you think about what your death could be like, what do you take comfort in?
    • When you think about dying, what worries you?
    • When you are nearing the end of your life, what or who do you want there?
    1. Decide what you want your healthcare to be like. What kind of end-of-life care options in BC will you accept, and which will you reject? 
    2. Choose your representative and attorney. Who do you want to make decisions about your healthcare and finances in the event that you can’t? They should be an adult you trust, someone who understands your wishes and has your best interests in mind. 
    3. Fill out your documents and put them in a safe place. Write out your wishes, values, and medical decisions in your advance directive. Appoint your healthcare decision-maker in a Representation Agreement. Once the documents have been signed and witnessed, keep them in a safe place, such as a Greensleeve, which you can get from your doctor. 

    After you’ve completed your documents, it’s important to also talk to your loved ones about your wishes and where you’ve stored your documents. This might also inspire your loved ones, like your parents, spouse, and friends, to create their documents as well.

    Patient rights and decision-making

    Your advance care plan is a legal way to state your wishes for health care and at the end of your life. Your advance directive will tell your family and your doctor what to do if you can’t communicate your wishes yourself. 

    Patient rights in BC healthcare dictate that patients need to provide informed consent to be treated. This means your healthcare provider must inform you of your diagnosis, including what treatment or health care they suggest, what the benefits and risks of treatment are, and any other treatment options, and you must consent for your treatment to move forward. 

    If you are unable to consent, someone must make the decision for you. 

    If you have an advance care plan, including an advance directive, you’ve already outlined your wishes, and no one needs to make them for you.

    If you haven’t outlined your decisions in an advance directive, your appointed Representative will make decisions for you.

    And if you have no advance directive and no appointed Representative, a temporary substitute decision-maker will be asked to make decisions for you.

    Who can be a temporary substitute decision-maker?

    BC law determines who can qualify to be on your list as a temporary substitute decision-maker (TSDM). To qualify, the person must be an adult (19 or older) who is capable of making decisions and has been in contact with you within the past year. They must also have no dispute with you. 

    The order of the TSDM list that your doctor or other health care provider receives is based on family law and cannot be changed:

    1. Your spouse (married, common-law)
    2. Your child
    3. Your parent or legal guardian
    4. Your sibling
    5. Your grandparent
    6. Your grandchild
    7. Anyone else related to you by birth or adoption
    8. Your close friend
    9. A person immediately related to you by marriage (in-laws, step-parents, step-children, etc.)

    If you do not like the order of your TSDM list or have someone else you would like to be your decision-maker instead, you will need to make a Representation Agreement to name them as your representative and primary decision-maker. 

    Tools for personal planning

    Willful offers resources to support your personal planning, including guides, estate planning checklists, and a team of certified estate planning experts to help you if you have any questions. 

    Start making your legal will and power of attorney documents with ease. 

    The easiest way to create your advance care plan in BC. Start yours for free →

    In addition to this article, you can also read more about BC personal planning tools with these articles:

    Other helpful resources for your personal planning include BC’s official guide on advance care planning, My Voice: Expressing My Wishes for Future Health Care Treatment, and the quick guide version, My Voice Advance Care Planning Guide Quick Tips

    How do you initiate advance care planning?

    Making your advance care documents is simple and affordable. 

    You can easily appoint your chosen decision-makers in your will, Representative Agreement, and enduring power of attorney documents today with an online legal document platform like Willful.

    Ready to start your estate planning journey and get peace of mind today?

    Take control of your tomorrow, today. Document your wishes on Willful →

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