One of the components of estate planning is to encourage our clients to begin thinking about their future health care treatment. Family, friends, and health care provider(s) can all be a great resource for discussion. These same individuals will want to know the health care treatment you would agree to, or refuse, if you become incapable of expressing your own decisions.
An Advance Care Plan is the act of writing down your beliefs and wishes, with specific instructions, regarding your future health care. It is a summary of our clients’ beliefs, wishes or instructions to guide a decision maker if asked by a physician or other health care provider to make a health care treatment decision on behalf of our client.
When we are having an estate planning meeting with clients, we will discuss creating an Advance Care Plan in three different parts. Part I is creating a Representation Agreement with a lawyer where our client writes out their instructions and names an individual to make their health and personal care decisions if they become incapable. Part II is creating an Enduring Power of Attorney, also done through a lawyer, where our client appoints someone to make decisions about their financial affairs, business, and property (but not their health care). Part III is an Advance Directive where our client’s instructions for health care are given to our clients’ health care provider, which they must follow directly when it speaks to the care needed if they become incapable.
My Voice: Expressing My Wishes for Future Health Care Treatment
When we meet with clients that want to discuss health care directives, we will provide them with a link to the B.C. government’s advance care planning guide called My Voice: Expressing My Wishes for Future Health Care Treatment. This is a good guide to learn about advance care planning and provides enough information to make their own advance care plan. The planning guide can be saved as a PDF version. One of the benefits of the online version is the ability to print the information and form pages that you want.
Conversations with Portfolio Manager and family
In addition to having conversations with us we encourage our clients to have detailed conversations with the family members or friends that they trust. The conversation will be about our clients’ beliefs and values. These conversations need to happen to ensure our clients’ wishes are dealt with properly. Selecting the right people to assist with your Advance Care Plan is an important step to ensure our client’s wishes will be honoured.
Communication of various health care treatments
Not all clients are the same. Some clients will want certain types of care and treatments while other will not. Having those conversations is part of the process. Clients can be on opposite sides of the spectrum with some choosing to accept life-supporting interventions, such as breathing machines and feeding tubes, while others might prefer to have no life support or life-prolonging interventions.
Medical Orders for Scope of Treatment
A Medical Order for Scope of Treatment (MOST) is completed by the Most Responsible Practitioner (MRP) and is written based on conversations with our client about their goals of care. A MOST has six different levels of treatment that range from palliative care to intensive care. Having a MOST in place will help ensure that our client’s health care treatment aligns with their wishes in the event they are unable to express their wishes.
A MOST is an option for everyone but is particularly important for our client’s with an advancing illness or chronic condition that shortens life expectancy.
Temporary Substitute Decision Maker
A Temporary Substitute Decision Maker (TSDM) is the individual chosen for you if you have not legally named another individual for you when you are incapable of making them for yourself. A TSDM is chosen by our clients’ doctor / health care provider. A TSDM must be 19 or older, be capable, have no dispute with you, and have been in contact with you in the past year. The order of the people who qualify to be on the list is determined by British Columbia law, and must be approached in the order given:
1. Your spouse (married, common-law, same sex - length of time living together doesn’t matter)
2. A son or daughter
3. A parent
4. A brother or sister
5. A grandparent
6. A grandchild
7. Anyone else related to you by birth or adoption
8. A close friend
9. A person immediately related to you by marriage (in-laws, step-parents, step-children, etc.)
The above list is determined by British Columbia law and our clients may not change the order of the list. A person lower down on the list may only be chosen as the TSDM if all the people above them do not qualify or are not available.
Documentation and communication
If you are comfortable with the above list, we recommend sharing the contact information for the people who could be individually asked to be your TSDM. If you want someone lower on the above TSDM list, to make your health care decisions, then you should name that person legally as your representative. We have written an article specifically about the different types of Representation Agreements and the appropriate forms to complete.
In some cases, we may have a client with several adult children, and they may wish to formally document who will be the representative. In other cases, we have had clients name a friend as their representative and not their children or sibling. Having a legally binding Representation Agreement will help ensure their wishes are documented. Health care providers would be required to call the Representative, rather than the chosen TSDM.
Advance Care Plan should be secured and accessible
When we meet with new clients, we request that they complete a professional checklist which outlines the key legal documents that they have. Creating an Advance Care Plan is an important process for our clients who have health conditions or are aging. Part of the checklist is making sure the people who need it, can find it, quickly. You can change your advance care plan at any time as long as you remain capable.
More Avance Car Planning Resources
There are a lot of resources available online to help get you started with your Advance Care Plan. Below are some links to additional resources:
BC Ministry of Health: Advance Care Planning
It’s Your Choice: Personal Planning Tools
First Nations Health Authority: Your Care, Your Choices
Kevin Greenard CPA CA FMA CFP CIM is a Senior Wealth Advisor and Portfolio Manager, Wealth Management with The Greenard Group at Scotia Wealth Management in Victoria. His column appears every week in the TC. Call 250.389.2138, email [email protected], or visit greenardgroup.com.
