Educate clients about advance care directives

Wanda Morris’s father-in-law spent the last month of his life strapped into a chair.

He became violent as a result of dementia, so doctors ordered he be restrained.

Morris, executive director of Dying With Dignity Canada, could have stopped medical interventions and prevented him from reaching that stage.

“Every year he got a flu shot, but dying of the flu—it’s the old person’s friend,” she says. “He had a knee infection we treated with antibiotics. We should have refused those treatments on his behalf.” Instead, he would have gotten medication to keep him comfortable, not cure his ailments.

Much of the guilt could have been taken off Morris’s conscience had her father-in-law signed an advance care directive (ACD), also known as a living will. Within an ACD, clients can stipulate what will happen in case of a terminal illness, irreversible medical condition, and dementia.

Under provincial laws, everyone has the right to:

• Appoint a substitute decision-maker for medical decisions
• Pain and symptom management, even if such treatment may hasten death
• Refuse treatment, even if this hastens death
• Discontinue treatment
• Refuse nutrition and hydration
• Refuse cardiopulmonary resuscitation (a Do-Not-Resuscitate order)
• Change doctors
• Have the ACD recognized by caregivers and medical professionals
• Be informed of all treatment options, and their probability of success

It’s easy for stretched hospital staff to forget a client’s wishes. So Morris recommends appointing a substitute decision maker to ensure directives are fulfilled; in Ontario, this should be the person named in the Power of Attorney for Personal Care. While the legality of an ACD varies from province to province, if your wishes are written out and witnessed, “It’s pretty hard for someone else to overrule it,” she says.

Why advance care directives are vital

• Prevent futile procedures and excess medication.
• Prevent conflict within the family over the proper course of action.
• Prevent guilt on the part of a substitute decision-maker.
• Empower the client to choose his or her end-of-life experience.
• Ensure client’s wishes are carried out.

Warning

If advance care directives name a substitute decision maker different from the person appointed in the power of attorney for personal care, the person named in the POA will have the legal right to make decisions.

Melissa Shin

Melissa is the editorial director of Advisor.ca and leads Newcom Media Inc.’s group of financial publications. She has been with the team since 2011 and been recognized by PMAC and CFA Society Toronto for her reporting. Reach her at mshin@newcom.ca. You may also call or text 416-847-8038 to provide a confidential tip.