The Advance Care Planning in Canada: A National Framework and Implementation Project was initiated in 2008. The long term goal of the project is to raise the awareness of Canadians about the importance of advance care planning and to equip them with the tools they need to effectively engage in the process. The secondary goal is to prepare professionals/health care providers with the tools they need so they can facilitate and engage in the process of advance care planning with their clients.
A Power of Attorney is a legal document that gives someone else the power to act on your behalf. This person is called your "attorney". In Canada the word "attorney" usually does not mean lawyer, as it does in the USA. You can give someone a Power of Attorney for Personal Care if you want them to make personal care decisions on your behalf if you become mentally incapable of making them yourself. This is sometimes called a "personal power of attorney". There are three kinds of Power of Attorney in Ontario: General Power of Attorney for Property, Continuing Power of Attorney for Property, and Power of Attorney for Personal Care.
An advance care plan is a written document which sets out a person’s wishes with regards to personal care and medical treatment. This document may include the person’s beliefs, values, and goals and will inform a substitute decision maker with respect to care decisions. The advance care plan can also be shared with health professionals; however, it is not a substitute for consent to treatment or personal care. Advance care planning is a process; through reflection and communication a plan is developed. In addition to the individual, advance care planning can involve family members, health professionals and financial or legal advisors, lawyers, or powers of attorney.
Why is it important?
Health care decision are becoming increasingly complex; advances in medical technology mean that people with complex conditions live longer, resulting in 73% of Canadians dying from chronic disease- this translates into a large proportion of Canadians who cannot make their own decisions near death
Patients who have end-of-life conversations with their doctors/family members are much more likely to be satisfied with care received, require fewer aggressive interventions at end of life, more likely to take advantage of hospice resources, place less strain on caregivers
End-of-life discussions and advance care planning can reduce moral distress for healthcare providers; affect outcomes such as completion of advance directives or powers of attorney for personal care; improve adherence to individual’s wishes
Concern over the future of one’s health and possible treatment (initiation, continuation, discontinuation) or care options
Think about what’s right for you: reflect on values, beliefs, your current understanding of medical procedures and what you need to know more about to be fully informed, situations experienced with others and how you felt, how you would feel if you were to pass away at home vs. hospital or a hospice, if you would want certain medical procedures such as feeding tubes, end-of-life expectations (e.g. being in pain), meaningful considerations (e.g. having friends/family nearby, music playing)
Learn about end-of-life options and medical procedures: discuss the different possibilities and options with your health care provider (3)
Think about who will make medical decisions on your behalf if you become incapable: this may be a spouse, a trusted family member or close friend
Have the conversation: discuss your values, wishes, and goals with your substitute decision maker, health professionals involved in your care, family members, lawyer or financial or legal professional, ask your health professional for any clarifications regarding medical treatment
Write down and record your wishes: document any changes and review your plan regularly and make your choices clear to others
Give your substitute decision maker the power to act: inform the chosen individual and complete the Power of Attorney for Personal Care
Advance Care Planning (ACP) is a process which gives someone the opportunity to consider and discuss with family, friends and health care team members their wishes and desires concerning future personal care options. This can be helpful in guiding their Substitute Decision Maker (SDM) if they ever become incapable of providing consent for health or personal care decisions. Some individuals may wish to write down preferences for care andtalk with health care providers or legal professionals.(1)
It is important for health care providers to understand the laws around capacity, consent and advance care planning for their province or territory. Health care providers should be comfortable providing information about the kind of care options that individuals may be offered in the future, educating individuals regarding the role and responsibilities of a Substitute Decision Maker (SDM) and supporting the individual to have conversations with their family and friends about their wishes.
Why is it important?
Health care decisions are becoming increasingly complex. Advances in medical technology mean that people with complex conditions are living longer; resulting in 70% of Canadians dying from a chronic disease.(2)
When surveyed, 6 out of 10 Canadians said that having end-of-life care discussions with at least one individual is extremely important. (3)
52% of Canadians indicated that the advance care planning process should begin when a person is healthy, but only 13% had started the process. (3)
Individuals who have end-of-life conversations with their doctors/family members are much more likely to be satisfied with care received, require fewer aggressive interventions at end of life and are more likely to take advantage of hospice resources resulting in less strain on caregivers. (2)
End-of-life discussions and advance care planning can reduce moral distress for healthcare providers; affect outcomes such as completion of advance directives or powers of attorney for personal care; improve adherence to individual’s wishes. (2)
Conversations should occur in a non-stressful environment and focus on individual’s principles, values and beliefs around end-of-life and what makes the individual’s life meaningful. Determine if the circumstances and burden of treatment outweigh the benefits of prolonged life; assess quality of life and discuss how the individual wants to live during the final stages (e.g. at home, pain-free). (2)
Focus on personal care: review possible treatments that may be considered for the individual’s condition, discuss implications of possible medical treatment (e.g. artificial ventilation, hydration, cardiopulmonary resuscitation), specify wishes with respect to organ donation or research participation, include their values, culture, faith and beliefs when discussing possible options.(2)
Health care providers should document discussions and decisions in the medical record and provide the individual with a copy; if they choose; it can be shared with family, loved ones, or substitute decision makers; periodically review and update the documents. (2)
It is important to ensure that the documentation is done in accordance with the provincial / territorial laws applicable.