Bob Parke is a bioethicist in Toronto. He worked at Humber Regional Hospital until his retirement. He continues to be a member of Advance Care Canada’s initiative to promote advance care planning nationally. Parke spoke with the deVeber Institute on the benefits of advance care planning. 

Advance care planning (ACP) is “the process of thinking about what matters most to you in your life and what that means for your health and personal care. ACP helps you share your wishes and preferences with the people who are important to you so they can help make sure you get the care you want.”

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Parke likes to think of “Advance care planning as a gift. A gift to yourself, your loved ones and the health-care professionals treating you.” 

When explaining this view, he recounted a time when he saw advance care planning bring peace to a grieving family.

“In this situation, when the family members were gathering — I believe it was for the funeral — they were challenging his spouse. ‘Why didn’t you have more aggressive treatment for your husband? Why didn’t you do CPR? Why didn’t you admit him to an ICU?’ and so on. Even though he had died, she was able to bring out the advance care plan and say, ‘This is what he wanted, and I respected his wishes.’ So even after he died she was at peace with the treatment decisions she made.” 

It’s important to note that while an advance care plan differs from a Power of Attorney for Personal Care, they are related documents. A Power of Attorney is a legally binding document that designates a person or people to be your substitute decision-maker(s) in the event that you are unable to make medical decisions for yourself. 

An advance care plan, on the other hand, is a conversation or document in which a person lays out their goals, values and wishes for medical treatment in the case that they become incapacitated. Essentially, an advance care plan is the roadmap that an Attorney for Personal Care should use to guide them as a substitute decision-maker. 

In Ontario, advance care plans can be expressed verbally, written and through audio/visual recordings. While an advance care plan is not a legal document, it does hold weight under Ontario law. 

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“The paper itself is not consent in Ontario. However, suppose you’ve done an advance care plan and it’s applicable to the circumstances. In that case, the law says that you shall abide by that,” Parke explained, referencing section 21 of the Health Care Consent Act, which addresses the principles of substitute decision-making in Ontario. 

Parkes also emphasized the importance of having both your advance care plan and Power of Attorney documents in an accessible place and ensuring that your substitute decision-maker knows where they are. 

“Some people have fridge magnets with information saying things are here or there to let people know where important documents are,” said Parke.

Another essential thing to consider when drafting an advance care plan is the specificity of language. For example, Parke once had a patient write “no heroics” in their advance care plan without defining what they classified as “heroics.” If an advance care plan is too vague, it cannot act as an adequate guide for health-care professionals and substitute decision- makers. Wishes would need to be understandable to be abided by. 

Arising from this experience, Parke recommends that if a person informs you that they have an ACP, take time to review it to understand that it reflects the person’s values and wishes and can be acted on if needed. 

Advance care plans aren’t just crucial for making sure that you don’t receive treatment you don’t want; they’re also important for letting health-care professionals know what treatments you do want. 

“I wish more of us, as health-care professionals, would open up the conversation as early as possible and accept that people may want full treatment, too. Advance care planning is a tool for people to let us know what they want. We tend to want to bias medical decisions toward comfort care and palliative care. Well, maybe my values are such that I want everything,” Parke said. “I’ve had patients that have taught me to question, ‘When do you believe death has occurred? When the brain stops or when the heart stops?’ These types of discussions are important to have so that an individual’s beliefs are honoured.”

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Advance care planning is within the continuum of palliative and end-of-life care, but anyone can make an advance care plan at any time. You don’t have to wait until you’re sick to begin thinking about your values and the kind of treatment you would want if you became ill. Having an advance care plan in place before you get sick is a good way to let your loved ones and health-care professionals know your wishes if you become suddenly incapacitated. However, it’s important to note that an advance care plan is not a one-and-done type of document. Values and wishes can change over time, especially as new treatment options that were not previously considered become available. As such, Parke recommends that you continue to revisit your advance care plans periodically to ensure that you are always getting the treatment you want. 

(This is republished with permission from the deVeber Institute.)