Topic Overview

What is advance care planning?

Advance care planning is making a plan for your future health care. Even if you're doing well now, it's a good idea to prepare for a time when you might not be able to care for yourself. It's also a good idea to plan for the end of your life.

It can be hard to think and talk about these issues. But planning for the future can help you to:

• Learn your options for care.
• Save your loved ones the stress of making hard decisions for you.
• Make sure your wishes are respected when the time comes.

It's best to do these things before you're in crisis and while you're still able to. Here are some things you can do to shape the future you want:

• Write an advance care plan to make sure your health care wishes are respected.
• Decide who will make health care decisions on your behalf if a time comes when you can't make them for yourself.
• Know what options you have when you reach the end of life.

And don't forget to communicate. Talk with your family and your health professionals. Your plans will do no good if no one knows about them.

What is an advance care plan?

An advance care plan is a summary of the kinds of health care you do or don't want to have if something happens to you and you can't make health care decisions for yourself. It tells your family and your doctor what to do if you're badly hurt or have a serious illness that keeps you from deciding what you want. An advance care plan also lets you appoint somebody (such as a family member or friend) to make health care decisions for you if you can't make them for yourself. This designated person is called a substitute decision-maker, or a health care representative, agent, or proxy.

An advance care plan also involves talking with your family, your substitute decision-maker, and your doctor about the kinds of care you do or don't want to have.

What does an advance care plan do?

An advance care plan has two main functions:

• It tells your family, your substitute decision-maker, and your doctor what kinds of treatment you do or don't want to receive as you near the end of your life and if you can no longer make these decisions for yourself. Depending on where you live, this part of an advance care plan may be called an advance directive or a personal directive. But many people also refer to it generally as a "living will."
• An advance care plan may also let you name a person to make treatment decisions for you if a time comes when you can't make these decisions for yourself. This person is called a substitute decision-maker, or a health care representative, agent, or proxy.

As long as you can still make your own decisions, your advance care plan won't be used. You can say "yes" or "no" to treatment at any time.

How do you write an advance care plan?

When you write your advance care plan, think about the kinds of treatments that you do or don't want to receive if you get seriously hurt or ill.

Consider whether you want to:

• Receive cardiopulmonary resuscitation (CPR) if your heart stops.
• Be on a machine that pumps air into your lungs through a tube if you can't breathe on your own.
• Be on a machine that cleans your blood if your kidneys stop working.
• Be fed or get fluids through a tube if you can't eat or drink.
• Take medicines to treat serious infections.

In some provinces, you need to make clear and give permission in your advance care plan that you don't want to be fed through a tube or receive other kinds of life support.

These are tough choices to make, but you don't have to make them alone. Take your time. Share your questions or concerns about what to include in your advance care plan with your doctor or nurse, your lawyer, your family, your substitute decision-maker, or a friend.

As you prepare your advance care plan, you'll need to follow these four important steps:

1. Get the advance care planning forms for your province or territory. Forms are different in each province, so be sure to get the right ones for where you live.
2. Choose your substitute decision-maker. This should be a person you trust to make decisions for you.
3. Fill out the forms, and have them witnessed as your province requires.
4. Give copies to your family, your doctor, and your substitute decision-maker.

You may be able to get the forms in a doctor's office, hospital, law office, provincial or local office for the aging, senior centre, or nursing home. For more information, talk to your doctor or contact your provincial ministry of health.

What if you want to change what is in your advance care plan?

You can change or cancel your advance care plan at any time. Just fill out new forms and get rid of your existing forms. Or you can just let your family, your doctor, and your substitute decision-maker know about the change. If you change or create new forms, tell everyone. Don't just cross out or add new information unless it's only to change your address or phone number.

Why an Advance Care Plan Is Important

An advance care plan is important in case something happens to you and you can't make health care decisions for yourself. It gives you control over your own health care if you're badly hurt or develop a serious illness and you can't make your own decisions. It's also very important for your family, your doctor, and your substitute decision-maker. They can use the information in your advance care plan to make choices for you if a time comes when you can't make them for yourself.

If you've done an advance care plan, share it with your family, your doctor, and your substitute decision-maker. Don't assume that they know what you want if you don't have one. This is a time when you can answer any questions they may have and be sure that they know what you want. An advance care plan eases the burden on your family so that they don't have to decide what is best for you. And it helps to make sure that your wishes are respected.

If you don't have an advance care plan that explains your wishes and names a substitute decision-maker, then a person other than your substitute decision-maker may decide what kind of care you receive. For example, a decision may be made by a doctor who doesn't know you, or it may even be made by the courts. Or depending on your province, a temporary substitute decision-maker may be asked to make decisions for you. That person may or may not be the person you would have chosen.

In some provinces, if you have an advance directive, then it will guide your care. In this case, your substitute decision-maker can't decide your care. He or she must respect your wishes outlined in your advance care plan.

Many painful conflicts about end-of-life care decisions can be prevented if you make an advance care plan, including naming a substitute decision-maker.

An advance care plan isn't for everyone. Some people choose not to have one for religious or spiritual reasons. If you don't want to have one, tell your family and your doctor. They should respect your wishes.

Preparing an Advance Care Plan

Get started

If you've decided to write an advance care plan, you've taken an important step to make sure that your health care wishes are respected.

When you write your advance care plan, think about the kinds of life-prolonging treatments you do or don't want to receive if you get seriously hurt or ill. If you have questions and need help to get started, see what things to include in an advance care plan for some ideas.

Involve your family, your substitute decision-maker, and your doctor as you write your advance care plan so they'll know more about your beliefs, values, and wishes for health care. If something happens that you didn't plan for, they'll have a better idea of the kind of health care decisions you would have made if you were able to.

There are many choices to make when you write your advance care plan. Some of these have to do with whether you want certain treatments.

These are tough choices to make, but you don't have to make them alone. Look to your family, your doctor, and your friends for help and support.

Write down your wishes

As you prepare an advance care plan, you'll need to follow these four important steps:

1. Get the advance care planning forms for your province or territory.
   • Forms are different in each province, so be sure to get the right ones for where you live.
   • You can get the forms in a doctor's office, hospital, law office, provincial or local office for the aging, senior centre, or nursing home.
2. Choose a substitute decision-maker. This should be a person you trust to make decisions for you. For more information, see the topic Choosing a Substitute Decision-Maker.
3. Fill out the forms, and have them witnessed as your province requires.
4. Give copies to your family, your doctor, and your substitute decision-maker. Keep the original form in a safe place. Don't keep it in a safe deposit box unless others can get to it. On each copy, write down where the original form is kept.

You can change or cancel your advance care plan at any time. Just fill out new forms and get rid of your existing forms. Or you can just let your family, your doctor, and your substitute decision-maker know about the change. If you change or create new forms, tell everyone. Don't just cross out or add new information unless it's only to change your address or phone number.