Advance Care Plans and Advance Directives
Advance Care Plan
Generally speaking, an Advance Care Plan is your voice, for when you're not fully able to speak.
Specifically, an Advance Care Plan is a written summary of a capable adult’s wishes or instructions to guide a substitute decision-maker on end of life wishes when the substitute is asked by a physician or other healthcare providers to make decisions about end of life care, possibly including healthcare treatment decisions, on behalf of the now incapable adult.
One of my primary duties as an End of Life Doula is to help you consider and plan for all the little things, both physical and emotional, that will help you enjoy life until the end of your days. In addition to my end of life training, I have completed two local training courses in Advance Care Planning and Medical Orders for Scope of Treatment - both from the Fraser Health Authority in BC.
The Advance Care Plan Umbrella
The Advance Care Plan (ACP) is a larger umbrella that encompasses several different considerations that you may want to document in end of life planning.
These include (see Glossary for certain definitions):
- Advance Directive - Specific medical instructions for heroic measures including CPR/DNR
- Representation Agreement - Either Section 7 RA (which does not include medical decision-making) or Section 9 RA (does include medical decision-making)
- Enduring Power of Attorney* - Financial and legal decision-maker if you become incapable (this is different than your “regular” POA you may have while you are still capable of expressing your wishes). I can document who holds these items for you and place a copy in your complete ACP binder.
- Funeral Home Selection and Bodily Disposition (e.g., cremation, burial, green)
- My End of Life Journey Expressed Wishes - The larger scope of everything else we can do to minimize your suffering and maximize the quality of your life at the end of your journey. This might include where you will stay, what visting and vigilling might look like for you, and what you want to happen during your final days. Read more about Expressed Wishes here.
Your complete Advance Care Plan can be saved securely online for only specific chosen people to have access, and I can also present your ACP to you in a book and on a flash drive.
Don't think you need an Advance Care Plan? Read about this Myth and others here.
Below are some terms related to Advance Care Planning that are helpful in understanding legal and desired documents. Please click on the term to see its definition.
Advance Directive is a capable adult’s written instructions that speak directly to their healthcare provider about the healthcare treatment the adult consents to or refuses. It is effective when the capable adult becomes incapable and only applies to the specific healthcare conditions and treatments noted in the Advance Directive, usually with respect to heroic measures.
Expressed Wishes collectively refer to everything non-medical and non-financial, the aspects of your end of life that are not covered by a CPR order or your Last Will and Testament, for example, where you hope to spend your final days and what you want those days to look like. Read more about Expressed Wishes here.
Representative is a person 19 years or older who is named by a capable adult, in a Representation Agreement, to make healthcare treatment decisions on their behalf when they are incapable of deciding.
Representation Agreement (RA) is the document in which a capable adult names their representative to make healthcare and other decisions on his/her behalf when incapable. There are two types:
- Section 7 RA: Adult may authorize a representative to make decisions about the routine management of financial affairs, personal care and some healthcare decisions on behalf of the adult, excluding decisions about the refusal of life support and/or life-prolonging medical interventions.
- Section 9 RA: Adult may authorize a representative to make personal care and healthcare decisions on behalf of the adult, including decisions about the acceptance or refusal of life support and life-prolonging medical interventions.
Temporary Substitute Decision-Maker (TSDM) is a capable adult chosen by a health care provider to make healthcare treatment decisions on behalf of an incapable adult when care is needed. A TSDM is not needed if the adult has an Advance Directive that addresses the care needed at the time, or if the adult has an available personal guardian or Representative.
Investing in Your Peace of Mind
Specific to Advance Care Planning, I offer two packages to help ensure that you have everything documented that you need to optimally have your wishes, values, and beliefs respected at your end of life. (For Doula care rates, please see here.)
Advance Care Plan Review
For those who already have Advance Care Plans of some sort, I will review your existing documents and make recommendations to ensure you have everything covered for your end of life plan.
Included is the review of your:
- Advance Directive or "Living Will,"
- Representation Agreement,
- CPR order,
- Power of Attorney*,
- funeral plans,
- and any Expressed Wishes you have documented.
I will then provide you with a document clearly outlining where there are gaps or conflicting information, as well as what else should be considered, and recommendations for moving forward.
End of Life Wishes Only
For those who already have an Advance Directive, aka "Living Will," and a Representation Agreement, but want to cover everything else between the medical world and the funeral world, I go through a detailed overview of considerations that you will want to have documented to ensure your final days are as comfortable as possible. Some people simply call this a "Comfort Plan" and we discuss aspects such as:
- where you hope to spend your final days
- clothing, bedding, and your general environment
- sights and smells and sounds
- spiritual considerations and rituals of passage
- alternative and complementary therapies
- and in the moment legacy work.
These wishes will be thoroughly discussed and documented. When you are satisfied that we've covered everything that you'll need to be comfortable and at peace during your transition, I will provide you with a written document as well as a flash drive for your records.
Advance Care Plan Creation
No idea where to start? I will walk you through the entire process using a specially-created guide book that covers every step that you need to consider for end of life planning. We will discuss aspects such as but not limited to:
- heroic and non-heroic medical interventions ("Living Will" or Advance Directive)
- healthcare Representative Agreement
- comfort measures and pain control
- residence, hospice, and home care settings and options
- end of life journey considerations, including comfort and spiritual requests
- legacy work and gifting
- funeral, burial, cremation, and Honouring Ceremony (Celebration of Life) options
- obituaries and eulogies
- Will and Power of Attorney*
Upon completion of all considerations, you will receive:
- a book complete with everything you need for a documented Advance Care Plan and Your End of Life Journey Expressed Wishes
- a personalized wallet card notifying others that you have an ACP
- a flash drive with all your documents
- a secure online drive setup with access for only your chosen representatives where all your documents can be easily accessed
*I am neither a notary nor lawyer, but I am willing to review your POA and Will to ensure that, from an end of life doula perspective, you have all your bases covered. I can then provide you with a list of my trusted network of colleagues of lawyers, notaries, funeral directors, and more, for you to contact, if you wish. I will also ensure that your POA and Will are part of the final collection of documents.