The Importance of Advance Care Planning

By Greg Barnsdale

There has been no other time in recent history where Canadian medical professionals have had to consider the potential reality of health care services being scarce. The world was ill-prepared for the Covid-19 pandemic, and the widespread shortage of ventilators was a prime example. Doctors and nurses had to evaluate situations where they were forced to deny some patients the care they needed (therefore, they died), so others could receive care and survive. This was new territory that ran against everything these professionals were taught to do. 

Medical care during the pandemic was frequently not as effective as it should have been, and the issue of unnecessary delays was a significant problem. Medical professionals have joined lawyers and financial planners in urging the public to have their health care wishes (Advance Care Planning) properly documented.  

Those who suffer from terminal health problems may not want life-sustaining medical technologies such as transplantation, feeding tubes, or ventilators used. Some in this unfortunate situation view this planning as a way of protecting themselves against technological interference that prolongs the dying process. They would rather die gently and naturally. Their quality of life is much more important to them than their quantity of life. Properly documenting their wishes provides them with that ultimate control. 

Becoming incapacitated can happen to any of us at any time, for any number of reasons. Accidents and changes in health can occur very quickly, regardless of age or current situation. Having a trusted substitute decision maker ready to make decisions is vital. When doctors and nurses are forced to deal with indecision and heightened emotions of family members when the patient cannot speak, immense frustration and wasted resources can easily result. 

Choosing the right person to speak for you can be difficult. That person should know you exceptionally well and respect your wishes even if they disagree. They should be willing to talk with you about your wishes, ready to come to your side in a hospital, and be prepared to speak up for you even if it is difficult. Emotions can run very high when someone is urgently hospitalized, especially when also incapacitated. The person you choose will be acting as your ‘fiduciary.’ Whether in life or death, the representatives/fiduciaries you select are always to act in your best interests. They are your advocate, your lifeline. 

Completing these documents while you can do so is crucial. Once mental capacity is diminished, this planning can no longer be completed. It is then too late. Establishing your power of attorney before it is needed is so much better than doing nothing. Ignorance is not bliss. Those who do not correctly plan in this way may be forcing those they love to deal with government authorities such as the Public Guardian and the Courts. This is not a responsible approach. 

Those you choose to act as your power of attorney fiduciaries need good ethical character traits. If you become incapable, they need to respect and fully understand that your relationships with others still need to be maintained. Just because they are not fond of certain relatives of yours does not mean they can keep you from them. Previous marriage situations come to mind. Their feelings must be set aside in favour of you, the donor. 

Determining mental capacity usually involves two physicians, each completing an independent assessment. I have included the stipulation within my own power of attorney that if my mental capacity is ever questioned (other than my wife’s opinion, which I don’t think should count), I want a professional capacity assessor to provide one of the assessments. A capacity assessor is a specialist in determining precise levels of cognitive abilities. Considering the increasingly stretched medical resources, I do not want to rely on two emergency room doctors who are run off their feet to quickly determine my mental status. I will have to live with the consequences, not them.