Senior Scene February 29,2016

Last week I introduced the topic of advance care planning (ACP) and highlighted the importance of making some of your health care decisions in advance so your loved ones were not left struggling with difficult choices. There is no legal requirement to do ACP and it will not influence your ability to get appropriate health care or move into a care facility.  It is your right however to express your care wishes, appoint a substitute decision maker (SDM) and to expect your wishes to be followed.


Once you decide to undertake the ACP process, you are faced with the selection of a SDM, or someone who makes decisions on your behalf if you become incapable of making them yourself. It is likely you will want to choose someone close to you, whom you trust and who knows you well. It is important that you discuss your intent to name the person ahead of time to make sure they are willing to act for you if it becomes necessary.


You can choose to appoint anyone who is willing and able to act on your behalf to be your SDM with the exception of the following:

  • someone who is paid to provide you with personal care (a homecare nurse, personal support worker, etc.), unless this person is your spouse, partner or relative
  • someone who is mentally incapable
  • someone who is under 16 years of age

Most people tend to choose their spouse, child or a sibling, or a combination of family members to act as their SDM, but it is best to keep in mind proximity and capability. As time passes you may want to reexamine your choice(s).


In the event that you become unable to make decisions, your doctor or other health care providers must contact your SDM to seek their consent before your doctor or other health care provider can give you treatment. An exception would be an emergency situation where a health care provider may not know your wishes and may have to act quickly. However, health care providers have to follow your wishes, if they know what they are, in any and all emergency situations.


Your substitute decision-maker must try to make the same personal care choices or decisions that you would have made in that situation, and follow your instructions if they were provided. He or she acts for you only when you are unable to make decisions yourself.  That type of situation could be temporary, or it could last for the remainder of your life.


As part of their role, your SDM must:

  • maintain close contact with you, involving you as much as possible in any decision about your care
  • obtain all the relevant information from your health care providers about your medical care, treatment(s), and available options and/or outcomes
  • adhere to your known care wishes as much as possible in making any decisions that come up about your personal care.


For some health care decisions, you may not have provided any instructions or your SDM may not know of any wishes you have that might apply. In that case, your SDM must consider your values and beliefs, weigh the probable benefits and risks of any course of action, and make decisions based on what he or she believes to be in your best interests.


The conversation will be concluded next week with some consideration to content for your ACP.