Advance care planning is a process of planning for a time when you may not have the mental capacity to make decisions about your health care. It usually involves choosing someone to make decisions on your behalf when you are not able to do so. This person is known as a substitute decision-maker.
A key element in advance care planning is the communication between you and your substitute decision-maker. If you have specific ideas about the type of health care or living arrangements that you may or may not want for yourself in the future, you need to communicate these ideas to your substitute decision-maker. Examples of information that you should share are your likes and dislikes, how you want to be treated, where you want to live, how you want to live and your specific wishes about health treatments, medications and end-of-life care.
In accordance with the Health Care Consent Act, your substitute decision-maker must follow your last known wishes when making decisions for you when you are incapable. You may have expressed your wishes in writing, verbally or by alternative means of communication (e.g., Bliss Boards or sign language). If your substitute decision-maker is not aware of any wishes applicable to the particular situation, he or she must act in your best interests and take into account your values and beliefs. The rules for how your substitute decision-maker must determine your best interests are set out in section 21(2) of the Health Care Consent Act.
Please note that advance care planning does not replace health consent. Even if you have expressed wishes about future health care, health practitioners (e.g., doctors, nurses, physiotherapists) must still get consent or refusal to consent before they treat you. That consent must come from you if you are mentally capable. If you are not mentally capable, health practitioners must turn to your substitute decision-maker for consent even if you have a written advance directive or any other form of advance care plan.
It is your substitute decision-maker that must determine if the wishes you have expressed about your future care are applicable to the decision that he or she must make on your behalf. That is why it is important for you to discuss any wishes with your future substitute decision-maker so that he or she understands what you want.
