Starting the Conversation: End-of-Life Planning, Part II

Advanced Care Planning is the process of discussing your options and sharing your decisions about how you want to be treated at the end of your life should you not be able to speak for yourself. It also allows you the ability to choose a person or persons to speak on your behalf should you be unable to communicate your own wishes.

In Canada, physicians are ethically bound to honor the directions of Advanced Directives. In Ontario, Advanced Care Planning decisions can be made orally or in writing. Having them in writing will best ensure that decisions are honored. Also important to remember is that you can change any of your decisions at any time, and that your decisions will only be carried out if you are incapacitated and unable to speak for yourself.

Developing Advanced Directives

Advanced Directives is a two-part process in Canada and is the way of letting others know what choices you would prefer for your health care should you become incapacitated and unable to speak for yourself.

• Make your choices known. Most times it is best to start this conversation with a physician to ask about the medical condition and the treatment and care options with potential outcomes of each. Only then will you be able to consider for yourself some of the following questions:
  1. What lifesaving measures do you want and for how long?
  2. Do you want your life prolonged even if in a vegetative state with no hope of recovery?
  3. Or would you prefer Palliative Care, the type that seeks to alleviate pain and other symptoms rather than provide restorative treatment?
• Appoint a Substitute Decision Maker. Not all situations can be covered completely covered by your Advanced Directives. In Ontario, you appoint this person by completing the Power of Attorney for Personal Care. This is the person who can speak on your behalf, should you be incapacitated, to make decisions based on knowing you and would what you would want.

Who do you trust to speak for your should you be unable to speak for yourself? Many folks choose the relative closest to us, but this person is not always suited for this responsibility. If this is the case, then it is important for you to talk in-depth with a few others to find out their comfort level in making the hard decisions. You need to flat out ask them the hardest question: If there was no hope for my recovery, would you be able to pull the plug on life support?

You can find an Advanced Care Planning Booklet specifically for Ontarians. Reviewing this booklet will give you ideas to think about for yourself and for broaching the topic with your loved ones. It can be a great conversation opener.Print multiples copies and work together on this as a project. If you still find this type of conversation difficult, then it ask for help from your physician, friend or a counselor.

It is a fact of life that we will all come to that day when forced to think about the end of our life. Most people avoid the subject, living life as if there is no end in sight. Like many difficult topics, we tend to put off any discussion to another day. Unfortunately, waiting until the last minute can be uncomfortable and distressing. If you wait too long then connections will be lost, questions unanswered and the burden of making important decisions will fall to the loved ones who most likely wont even know what choices you would make. Remember, your choices and decisions are only as good as who you communicate them to… share them with your family, your physician and even your lawyer.