WHAT ARE THEY?

What happens when we can't give directions for ourselves about our medical treatment? Who will make those decisions for us?

In British Columbia , there are laws that offer some help. They have created a list of people who can make health decisions for you. The power falls to the first person on the list, and so on down the list to the next able and willing person. In this Province, the first in line is a person named in a Personal Representation Agreement and thereafter a spouse, child parent or sibling.

Too many seek to solve the problem of being unable to make health decisions by writing out a simple "Living Will", from a drugstore form or Internet source. Unfortunately, such wills relate only to end of life treatment. They do not allow the selection of your decision maker in advance. Some may feel comfortable that your family will follow your wishes and instructions in the living will. This can be a dangerous assumption. Others are wiser and can envisage a big family fight over who should make the decision. This puts the attending Doctor in a difficult and unwanted position. Should he listen to the eldest daughter or the new young second wife-for example? There is no guarantee that the instructions in a living will shall be followed. General statements in living wills can make it difficult for medical staff to follow. Words such as "not kept alive by artificial means" or" experimental treatment of low success", cause vagueness and wide interpretation for different people. No province has passed laws that clearly recognize living wills.

NOW, almost all provinces, including B.C. have passed laws that clarify the issue by the appointment of a substitute decision maker. As a result of studies conducted, many stressed the need for clear guidance for those in the medical field for treatments a patient may or may not want.

The document that allows for this function is called different names. In Alberta it is called a Personal Directive. In B.C., we have a Personal Representation Agreement. (PRA). This allows a person of 19 years or older, of sound mind, can give advance instructions on their wishes health or personal care. Such documents carry great importance and responsibility, are properly prepared by Lawyers and signed before them with an attached Certificate of Consultation.

The first decision is the most important in preparation of your PRA. This is whom you chose as the best person to be your decision maker. The person should be fully trustworthy and be very aware of your wishes, beliefs and willing to follow your directions. Discussions with your Representative on your wishes well before needing the document is recommended.

Secondly, consider the exact directions. The Agreement can indicate instructions on health care, (surgeries, transplants and life support, for example), accommodations, where and with whom they wish to live or provide access to confidential documents.

PRA's in B.C. should be fully explained and signed before a Lawyer who can certify that he or she has explained all provisions. After confirming they that they were understood, a Certified Consultant Certificate is signed. In B.C. it is also required that a named representative confirm in writing that they understand their duties and obligations as set out in the B.C. Representation Agreement Act.

You should advise your Doctor, your named Representative and family members you have such an Agreement executed. Of course your first Representative must sign as well. An Agreement is of little value, if the people involved do not know of its existence and whereabouts.

Your Representative should be close by if at possible, for urgent situations.Your Agreement can be cancelled or changed at any time, as long as you maintain good mental health. Newcomers to B.C. should be aware that many lawyers question whether Personal Directives from another province would be legally enforceable in B.C. without the required terms.

Your Personal Representation Agreement can contain important terms such as the authority to approve certain surgeries, or authorize the withdrawal of treatment. It can include the right to have you forceably removed to a care home, if in your best interests, even when in your diminished mental state, you then object. The Personal Representation Agreement is an important part of Estate planning along with a Will and Enduring Power of Attorney. It can avoid delays in surgery decisions that could be life threatening.

Be among those who show consideration for your own self worth and the difficult position you place your loved ones and your Doctors, by seeking preparation of your own Personal Representation Agreement.