Living Wills

by Del Elgersma

Thanks to the adult guardianship legislation that became law on February 28, 2000, "living wills" are now legally valid in BC. A living will is a written statement that expresses your wishes regarding medical treatment and personal care in case you are unable to express your wishes at the relevant time. Living wills are also referred to as advance directives, health care authorizations or declarations of belief.

A living will specifies the treatments that should or should not be given in specified circumstances. For example, many living wills provide that "heroic measures", such as cardiopulmonary resuscitation (CPR), should not be used to prolong life if the person suffers from a severe irreversible condition. However, it may direct that medication be administered to alleviate suffering in those circumstances.

Living wills can prevent conflict and guilt among family members. If family members ask the doctors to do "everything" to keep a loved one alive and that person dies, the family may feel guilt for putting the person through needless tests and treatments. On the other hand, if they let their loved one "die with dignity", they may feel later that they should have done more.

Conflict can also arise if family members cannot agree. Children who have been out of contact for years may return and want the doctors to do "everything" to try to bring a parent back so they can make peace. Other family members who remained in close contact are more likely to accept the person's death, and want only palliative care for the parent. Further complications can arise when children from divorced marriages resent stepparents or common law spouses from making decisions. These conflicts can leave lasting bitterness.

If you have stated your wishes clearly in a living will, your doctor and family won't have to second-guess what kind of treatment you would want. You will receive the treatment you want and your family will be "off the hook".

Under the new Representation Agreement Act, you may make a Representation Agreement authorizing a representative to give consent or refuse consent to specified kinds of health care, including life-supporting care. This authorization is valid only if you consult with a lawyer before making the Representation Agreement, and the lawyer completes a certificate to that effect. (Representation Agreements replace enduring powers of attorney in B.C.)

Although a Representation Agreement is the most effective form of living will, other less formal methods of leaving directions are available which still have legal effect. A living will that is not a Representation Agreement is given effect under the new (and unfortunately named) Health Care (Consent) and Care Facility (Admission) Act. Under this Act, if a patient is incapable of giving or refusing consent to medical treatment, the health care provider is to go to the highest ranking of the following people who are available and willing to decide:

• the patient's court appointed guardian (committee), if any, or representative under a Representation Agreement, if any
• the patient's spouse (including common law or same sex spouse)
• adult children
• a parent
• a sibling
• anyone else related by birth or adoption
• if no one else is available, someone authorized by the Public Guardian and Trustee.

The person making the decision will be bound to comply with any wishes expressed by the patient while the patient was still capable. Accordingly, a living will that is not a Representation Agreement can still be binding (although it won't authorize who can make the decision for the patient - that can only be done in a Representation Agreement). If no wishes are expressed, the person must decide on the basis of the patient's known beliefs and values. If the patient's beliefs and values are not known, then the decision must be made on the basis of the best interests of the patient.

In the past we recommended that our clients plan for the possibility of disability by considering an enduring power of attorney. A Representation Agreement is an even more effective tool, as it gives you the ability to include legally valid instructions for your future medical treatment and health care. The ability to make these decisions is long overdue in B.C. For more information about living wills and Representation Agreements, please contact us.