Make Type:

Larger Smaller Reset

Learning Centre

Living Wills: Making Your Wishes Known

By: Marie Howes, CFP, R.F.P.

There is a lesson for each of us in the recent sad case of Terri Schiavo in the U.S. - explain your wishes concerning medical decisions in a legal, workable Power of Attorney for Personal Care while you are still capable!

There are two types of Power of Attorney. The most widely used and understood is Power of Attorney for Property. It simply means that you appoint another individual to act in your place should you become incapable of taking care of your own business, legal and financial affairs. The person you select, called the "attorney," has virtually the same rights and powers you would exercise if you were capable of acting on your own.

The second type is the Power of Attorney for Personal Care. It is also known as a Living Will or an Advanced Care Directive, or similar form, depending upon the province in which you live. This document is not as well known or used. The person (or persons) you select as your representative or attorney has authority to make decisions concerning your medical and health care only. This includes health procedures and decisions regarding prolonging your life through life support. Let us refer to that person as your health care representative (HCR).

Consider these areas when you decide to set up a Living Will.

Lifestyle and Quality of Life Issues

Ailments, accidents and aging bring varying degrees of pain and suffering to everyone. The question is, at what point does the pain and discomfort make you feel that you do not want to continue the fight to live on? There are also religious and cultural factors that affect your decision.

Everyone assumes that they will receive basic, standard medical care. The personal question, "What makes my life meaningful?" is more complicated. If you cannot walk or see or hear or communicate with others or if you experience severe pain at all times, does that necessarily mean that your life will lack meaning or joy or hope? The difficult part comes when you have to decide if you want extraordinary measures used to keep yourself alive. Do you want invasive life support procedures if you are living in a "persistent vegetative state?" Or do you want only to be made comfortable with medications and the quiet surroundings of a hospice? These are only some of the questions that you must explore before setting out the conditions that you want your HCR to follow when you are medically incapacitated. (Contact Dying with Dignity, www.dyingwithdignity.ca ; Choices in Dying, www.choicesindying.com ; and the University of Toronto Centre for Bioethics www.utoronto.ca/jcb/outreach/living_wills.htm for more checklists and tools to help you devise your own Living Will.)

Medical Realities

There is a danger in stating in a Living Will that you do not want X, Y or Z procedure used as part of your medical care if you become incapacitated. With time, medical procedures are becoming more and more successful in curing illnesses and reversing formerly incurable conditions. Just because there is no cure now or life-prolonging procedures are onerous and uncomfortable for a particular condition, does not mean that it will always be that way. What may seem unbearable now, may become comfortable and commonplace in the future.

Your representative's role

Before appointing someone as your HCR, understand their views on medical procedures and life-prolonging therapies. An open discussion of the Schiavo case can be a revealing exercise. If your potential representative was more sympathetic to one side or the other in that case - and if your view favoured the opposite side - then you will have to consider another possible representative.

While the Living Will (as authorized under the various provincial laws) has legal force in most provinces, remember that your wishes can be challenged by family members or even the office of the public guardian in your province. Actions that can be construed as assisting suicide or euthanasia are not permitted under Living Wills. In some instances, doctors are reluctant to abandon extraordinary measures to keep patients alive because they fear legal action from disgruntled family members.

Action Plan

• Get information and "talking points" about Living Wills from such sources as noted above.
• Give broad instructions to your HCR; don't specify procedures but focus on "conditions" such as whether you want extraordinary measures to be used.
• Even if you do not make out a Living Will, your province has a hierarchy of individuals who will be called upon to make decisions on your behalf if you become medically incapacitated. Just be sure to make clear, especially to those nearest and dearest to you, your broad views on when pain reduction and life-prolonging actions should be taken on your behalf.