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Well Wishes
 
What is an Advanced Care Directive?
 
In 1997, legislation was passed in Saskatchewan which allows us to tell our physicians and the health care system how we would like our care managed in the event that we are unable to speak for ourselves.
 
Although it is a difficult issue, it is important for people to discuss within the family. In the event that you become ill and cannot speak for yourself, who do you want to speak for you?
 
Medical techniques and treatment have advanced to the point where we can be kept alive by various methods. It is advantageous for each of us to think about what we would want in advance. Some will want everything done while others will not. Your personal wishes should be respected.
 
The following information is for completion of Advanced Care Directive / Directions for Care:
 
Advanced Health Care Directive is completed by a client when they are able to make decisions for themselves.
 
 
Directions for Care is completed by a client representative or power of attorney assigned to make health care decisions in the event the client is unable to do so.

BENEFITS

  • You do the decision making.
  • You get the chance to discuss your wishes regarding your health care before difficult situations arise and before you are unable to decide.
  • You can choose within a range of choices and/or you can make specific wishes.
  • You can change your advanced directive any time you want.
  • Your family, physician, and health care worker would know exactly what your wishes are when you cannot decide for yourself.  Therefore, difficult situations, indecision, poor communication and bad feelings would be avoided.
  • Completeing an advanced directive would promote an atmosphere at the end of your life which is comfortable for everyone involved.

 

PROXY

In your advanced directive you can name another person to make health decisions for you.  The other person will make decisions for you when you are not able to make or communicate decisions yourself and your directive does not address the issue.  This person is called a proxy.  A guardian of a dependent adult has the responsibility of health care decision making.  A person who has power of attorney which includes health care decision making is a proxy.

A proxy does not need to be a family member.  You can choose any person who is at least 18 years old and has the capacity to make health care decisions.  A married person who is not yet 18 years old and has the capacity to make health care decisions can also be a proxy.  You may name two or more proxies if you wish.  These may be named as alternate or joint proxies.  You should choose someone you trust as your proxy.

Treatment wishes should be discussed clearly and completely with your proxy.  If your proxy knows your wishes he or she must act according to your wishes.  If your proxy does not know your wishes, your proxy must act according to what he or she believes is in your best interest.
 
A proxy is responsible for making health care decisions for you.  Your proxy cannot choose another person to make decisions about your health care.
 
This person may have been designated if you signed a power of attorney which included health care decision making.
 
 
NEXT OF KIN
 
If you have not named a proxy and you become ill and incapable of making health care decisions, another person may still make decisions for you.  That person will be your nearest family member.  Your nearest relative is determined in the following order:
  1. Your spouse or person you live with as a spouse
  2. Your adult son or daughter
  3. Your parent or legal custodian
  4. Your adult brother or sister
  5. Your grandparent
  6. Your adult grandchild
  7. Your adult uncle or aunt
  8. Your adult nephew or niece

If there are no family members or the family members cannot be found, then your physician or other health care professional will make decisions for you by consulting with another physician.

The second physician must agree in writing that the proposed treatment is needed.

COMPASSIONATE/COMFORT MEASURES

This may include, but is not limited to:

  • Medication for relief of pain and symtoms
  • Provision of fluids by mouth only (provision of fluids by intravenous or feeding tube would not ordinarily be done)
  • Body positioning to maintain as high a degree of comfort as possible
  • Mouth care and cleaning
  • Suctioning to maintain a clear airway
  • Oxygen therapy (blood tests or x-rays would not normally be done)
 
MEDICAL MANAGEMENT
 
This may include but is not limited to:
  • All comfort measures as indicated above
  • Surgery
  • Invasive tests ie. colonoscopy, cystoscopy
  • Non-invasive tests ie. ultrasound
  • Transfusions of blood and /or blood products
  • Intravenous medication and fluid replacement
  • Tube feeding
  • CPR if specified

SPECIFIC WISHES

Examples may include, but are not limited to:
  • If my heart is restarted with CPR, but I will have not quality of life, I do not want to be kept on a ventilator
  • I want tube feeding if I am no longer able to swallow
  • I want intravenous feeding if I am no longer able to swallow
  • I do not want to be transferred to another facility
  • I do not want surgery
  • I do not want blood transfusions
  • I consider an irreversibe condition to be....

ENDING OR CHANGING A DIRECTIVE

If you no longer want your directive to be binding, you may revoke it orally or in writing.  You may also destroy it or make a new directive which will revoke your old directive.

It is recommended that you review your Advanced Directive annually to ensure it continues to accurately reflect your wishes.  This review should be initialled and dated on the form.