In keeping with the philosophy, mission and values of St. Joseph's Health Centre, healthcare providers have an ethical obligation to provide quality care. This includes helping patients and families make decisions about life-sustaining treatment and end-of-life care.

It is important to talk with family members and caregivers to express our feelings about health care and life-sustaining treatment before crisis situations arise. That way, we can provide direction for family and caregivers if we are unable to speak or otherwise express our decisions.

What is an Advance Directive?
An Advance Directive is a document that is used to instruct or inform others concerning the type of life-sustaining treatment you want, should you lose your decision-making capacity or be unable to make your wishes known.

There are two types of Advance Directives:

• Instruction Directives, such as living wills, are written documents that focus on the life-sustaining treatment you would want in various medical situations. In Ontario, the legal form of documenting an Advance Directive is called a “Power of Attorney for Personal Care”.
• Proxy Directives, such as a durable power of attorney for health care, are documents that appoint someone who will make health care decisions on your behalf if you can no longer do so.

If you choose an Advance Directive, remember...

• An Advance Directive does not replace talking with people.
• It is extremely difficult to anticipate the many health situations that we might confront in the future. It is equally difficult to project how we would feel and what we would want in such situations.
• Unclear directives can be problematic.
• You can change your instructions or the person you wish to act as your proxy at any time, while capable. You can review and discuss your directive as often as necessary.
• Give copies of your directive to your proxy, doctor and family members.
• You do not need a lawyer to complete your Advance Directive. However, a lawyer can give more specific information about laws regarding Advance Directives in your province.
• A decision to forego life-sustaining treatment does not mean that you will cease to receive medical care. Canada is viewed as an international pioneer in palliative care. Palliative care strives to decrease suffering and enhance physical, emotional and spiritual life when a person is near death.

If you choose not to prepare an Advance Directive, remember...

• That does not mean you will receive inappropriate care or be treated contrary to your wishes. The basic principle of health care is respect for the value and dignity of each person.
• You still have the right to discuss your health situation and treatment options with your doctor and make decisions about the type of care you will receive. This includes the right to refuse nonbeneficial treatment when death is clearly imminent and inevitable.
• Should you be incapable of making health care decisions, your health care team will still consult with your family about treatment decisions. The tradition of consultation between the health care team and family still applies. In the event that you require emergency treatment and it is not possible to consult with your family or substitute decisionmaker (SDM), you will still receive treatment consistent with the law.
• For this reason, if you choose not to prepare an Instruction Directive or to formally designate a proxy, it is important that your spouse or family members understand your wishes.

Discussing these issues requires sensitivity and compassion. People can become quite alarmed when asked to confront issues related to terminal illness. A number of conversations may be required when discussing your Advance Directive.

For more information please download our brochure on Advance Directives.

Resources

We encourage you to reflect on life-sustaining and end-of-life treatment issues and to discuss these matters with your loved ones. The following are resources that may be of assistance:

Catholic Health Association of Canada (CHAC)
1247 Kilborn Place
Ottawa, Ontario
K1H 6K9
Tel: 613-731-7148
www.chac.ca

Facing Death, Discovering Life by James W. Roche (2000)
Available from the Catholic Health Association of Canada

University of Toronto, Joint Centre for Bioethics (JCB)
88 College St.
Toronto, Ontario
M5G 1L4
Tel: 416-978-2709

Living Will
This 29-page booklet is helpful in providing descriptions of a variety of health situations in which a living will may be needed. It is available at the University of Toronto Joint Centre for Bioethics (JBC) website.

Power of Attorney Booklet
Available from The Public Guardian and Trustee
595 Bay Street, Suite 800
Toronto, Ontario
M5G 2M6
Tel: 416-314-2989

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Page last updated: April 30, 2010