1 ADVANCE CARE PLANNING EXPRESSING MY WISHES FOR

1 ADVANCE CARE PLANNING EXPRESSING MY WISHES FOR FUTURE HEALTH CARE DECISIONS Dawn Dompierre, ACP RN, Seniors Health

PARTICIPANTS WILL: 2 Understand why Consent to Health Care is needed q Understand what Advance Care Planning is q Understand why Advance Care Planning is important q Learn how to complete your own Advance Care Plan q

DEFINITIONS 3 Advance Care Planning: is a capable adult's planning for how consent to health care will be given/refused after he/she loses capability q a process of learning, deciding, talking about, and documenting or otherwise expressing what health care an adult wants or does not want in the future q based on and must be consistent with the law

DEFINITIONS continued 4 Enduring Power of Attorney: allows you to appoint someone to make financial and legal decisions on your behalf even after incapable q It does NOT cover health care decisions

DID YOU KNOW. . 5 q 86% of Canadians have not heard of advance care planning only 9% had ever spoken to a healthcare provider about their wishes for care over 80% of Canadians do not have a written plan only 46% have designated a Substitute Decision Maker – someone to speak on their behalf if they could not communicate Advance Care Planning language Living Wills: U. S. term Advance Care Planning Representation agreement, Advance Directive, Expression of wishes POA: Finances in BC March 2012 Ipsos-Reid national poll

MY STORY 6

HEALTH CARE CONSENT: A health care provider must not provide any health care without the consent of the adult or a substitute decision maker. 7

WHAT DOES CONSENT MEAN FOR… You: • right to be informed • right to accept, refuse or change your mind to health care treatments 8

WHAT DOES CONSENT MEAN FOR… 9 Health Care Providers • • legally required to seek/obtain valid consent before treating are required to provide enough information to help patients informed treatment decisions

SUMMARY: SEEKING CONSENT 10 Incapable adult Capable Adult Inform patient and seek valid consent from: Inform patient and seek valid consent 1. Adult’s Committee of Person or 2. Adult’s Representative or 3. Adult’s Advance Directive or 4. Temporary Substitute Decision Maker or 10 5. In emergency, when above are unavailable, act on adult’s known wishes

PRESUMPTION OF CAPABILITY 11 § § Until contrary is demonstrated, every adult is presumed capable of giving, refusing or revoking consent to health care, and An adult's way of communicating is not grounds for deciding that he or she is incapable of making decisions. - Health Care (Consent) and Care Facility (Admission) Act, s. 3 11

CAPABLE ADULT 12 Every capable adult has the right to give, withhold, or revoke consent to health care. 12

HOW TO DETERMINE CAPABILITY: 13 Incapable Capable • § § § 13 understand: able to understand information about treatment offered, incl. risks/benefits appreciate: able to apply to own situation thus, able to understand consequences of decision usually determined by health care provider offering treatment § § § • unable to understand consequences of decision may be temporary or not may be due to: • unconsciousness • extreme pain alcohol or drugs • cognitive loss or dementia

ADVANCE CARE PLANNING: 14 Definition: § Advance Care Planning is a capable adult's planning for how consent to health care will be given/refused after he/she loses capability

ADVANCE CARE PLANNING IS NOT… • • • something that just happens once (an ongoing process) just filling out a form one conversation with health care provider or family and friends just about what you don’t want a private document in a safety deposit box where no one can find it 15 15

ADVANCE CARE PLANNING BASICS My Voice: 16 Page 8 P. 30 P. 28

BELIEFS, VALUES & WISHES 17 Page 30 in My Voice

QUALITY OF LIFE 18 What brings you comfort? What are your food preferences? Who is important to you? What are your religious, spiritual or personal beliefs? What are your medical treatment preferences?

LIFE THREATENING ILLNESS DO YOU WANT: 19 • • • Cardiopulmonary resuscitation? All, some, or no life support or medical interventions when a health care provider says the treatments are medically appropriate? A trial period?

LIFE SUPPORT AND LIFE-PROLONGING MEDICAL INTERVENTIONS 20 Important to think about this. . . Advance Care Plan can address different situations • Ventilator to help with breathing • Tube feeding • Kidney dialysis • Cardio Pulmonary Resuscitation (CPR)

CARDIO-PULMONARY RESUSCITATION (CPR) 21 If your heart stops If healthy: • CPR good chance of recovery if given on time If very sick, weak or dying: • • CPR nearly always unsuccessful Brain death begins 4 -6 minutes after your heart stops

PARAMEDICS & EXPRESSED WISHES 22 Expressed Wishes: Paramedic will attempt resuscitation even if adult has expressed wish not to be revived (in document or family requests) 22

23 PARAMEDICS & ADVANCE DIRECTIVES Will only withhold if there is: 1. Physician’s No CPR Order Or 2. Advance Directive: Paramedic who has reasonable grounds for believing adult has made advance directive, as defined in Health Care (Consent) and Care Facility (Admission) Act, that refuses consent to emergency procedure, must not perform that procedure.

HOW DO I DECIDE ABOUT CPR? 24 • • • Talk to your doctor or other health care providers. Think about your own values and beliefs Be sure to have up to date knowledge about your current health condition

WHERE DO I PUT IMPORTANT MEDICAL INFORMATION? 25 A copy: On your fridge (Paramedics may only check for it there) Copy to family doctor Copy for your friend(s) or family member(s) Copy with other health care providers involved in your care

ADVANCE CARE PLANNING BASICS My Voice: 26 Page 8 P. 30 P. 28

YOUR CONTACT INFORMATION 27 Page 28 in My Voice

TEMPORARY SUBSTITUTE DECISION MAKERS (TSDM) 28 Health care provider chooses a TSDM if you have not legally appointed an individual (representative) Criteria: q adult (19 years or older) q be capable q have been in contact with adult in last 12 months q have no known dispute with you 28

29 DUTIES & LIMITATIONS OF (TSDM) Follow capable adult’s expressed wishes or (if no wishes expressed) q q q 29 Make decision based on best interests including current wishes, values and beliefs TSDM is not able to make end of life decisions unless there is substantial agreement by health care providers

TEMPORARY SUBSTITUTE DECISION MAKER (TSDM) 30 My Voice: Page 9 spouse (incld. common-law & same sex) § adult child § parent § brother or sister § Grandparent New § Grandchild New § another relative by birth or adoption § close friend New § person immediately related by marriage New § another person appointed by Office of the Public 30 Guardian and Trustee §

WHAT IF I WANT TO CHOOSE? 31 If you want to choose someone to make your health care decisions and be your advocate when you are incapable, You must appoint a person by making a Representation Agreement

ADVANCE CARE PLANNING OPTIONS Page 8 in My Voice 32 P. 34 -43 P. 44 -49 P. 50 -51

33 REPRESENTATION AGREEMENT Representation Agreement Act allows capable adult to appoint someone to make health and personal care decisions Section 7 Agreement Adults with less than full capability For routine health and financial decisions or Section 9 Agreement Fully capable adult power to refuse life-sustaining treatment

SECTION 7 REPRESENTATION AGREEMENT 34 q q q Allows you to name a representative for routine management of finances, your personal care and minor health care treatment decisions Does not allow them to make decisions involving life support or life prolonging interventions Allows adults with lower levels of capability (e. g due to developmental disabilities or injuries/illness that affect cognitive ability) to do some advance care planning

SECTION 7 REPRESENTATION AGREEMENT 35 EXAMPLE: • Micheal, 38, motorcycle accident 10 yrs ago • Head injury & paralyzed &memory problems • One younger brother, outside of the province • Lives alone My Voice: • Dependent of friend Ben Page 11 Michael may wish to complete a section 7

SECTION 9 REPRESENTATION AGREEMENT 36 You name a representative to make decisions about: • • My Voice: Page 12 personal care health care treatments: accepting/refusing life support accepting/refusing life-prologing medical interventions

SECTION 9 REPRESENTATION AGREEMENT 37 EXAMPLE: • • Gurdeep, 74 - poor health Wife Rani speaks little English Couple lives with oldest son Jeet 5 children My Voice: Page 13

38 REPRESENTATION AGREEMENT (SECTION 9) My Voice: Page 44

39 NEW PLANNING TOOL: ADVANCE DIRECTIVE A capable adult can create an Advance Directive q Advance Directive is a document that gives/ refuses consent to specific treatments in advance q Legally binding document for health care providers, document is used as the source of consent without an intermediary q Legal and medical advice is recommended before completing q 39

ADVANCE DIRECTIVE 40 EXAMPLE: • Mary 93 • No family or friends

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ADVANCE DIRECTIVE FORM 42 My Voice: Page 50

WHY WOULD YOU WANT AN ADVANCE DIRECTIVE? 43 You don’t have anyone you want to name as a Representative q You may have strong feelings about certain medical treatments and interventions and want your instructions to be legally binding q You have a Representative, but you do not want him/her to have to make certain decisions q

BARRIERS TO PLANNING q q Reluctance to discuss death and dying Inadequate knowledge about consent and advance care planning (“my doctor will decide”) Belief that it is physician’s role to initiate advance care planning discussions Belief that advance care planning is unnecessary b/c “my family will know what to do/know what I want” 44 44

BENEFITS OF ADVANCE CARE PLANNING 45 Individuals who engage in Advance Care Planning and/or appoint a Representative are more likely to: q Significantly reduce stress for family members q Have a better quality of life and death q Have their end of life wishes known and followed

RESOURCES 46 § BC Seniors: http: //www. seniorsbc. ca/legal/healthdecisions/ Speak UP Campaign: http: //www. advancecareplanning. ca/ § § 46 VIHA Internet site: http: //www. viha. ca/advance_care_planning/

OTHER RESOURCES 47 VIHA ACP Intranet- Learning Hub VIHA Consent To Health Care and Advance Care Planning Policy FAQs VIHA's Public Advance Care Planning Website ACP Pamphlets ACP Public Session- Victoria Area Health Care (Consent) and Care Facility (Admission) Act Health Care Providers' Guide to Consent to Health Care ACP: Course Renal Services Intranet (Intranet-Renal Services-End of Life) Advance care planning: Getting Started Advance care planning: Starting a conversation

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Dawn Dompierre ACP RN Tel: 250. 544. 7600 ex 22017 E-mail: dawn. dompierre@viha. ca 49 Thank You