Understanding Advance Care Planning in Ontario: A Guide to Making Your Healthcare Wishes Known

In Ontario, planning for future healthcare decisions involves creating a Power of Attorney for Personal Care (POAPC). While it might seem daunting, understanding your options helps ensure your future care aligns with your values and wishes. By documenting your preferences and choosing the right person to advocate for you, you take an essential step toward maintaining control over your healthcare decisions, even when you’re unable to make them yourself.

The Ontario System

Unlike some provinces that use the term "advance directive," Ontario has a specific framework for advance care planning. The process involves two main components: choosing someone to make decisions for you (your attorney for personal care) and expressing your wishes about future care.

What makes Ontario unique is that medical professionals cannot follow written instructions in isolation. Instead, they must seek consent from your substitute decision-maker (SDM) in the moment. This emphasizes the importance of selecting the right SDM and ensuring your preferences are documented and communicated clearly.

For more details about Ontario’s framework, visit the Ontario Ministry of the Attorney General.

Choosing Your Attorney for Personal Care

In Ontario, your "attorney" is the individual you trust to make healthcare decisions on your behalf. This person doesn’t need to be a lawyer but must be someone who knows you well, understands your values, and has the emotional strength to advocate for you during challenging situations.

When selecting your attorney, consider whether they:

• Live close enough to assist promptly when needed.
• Can handle emotional situations calmly and thoughtfully.
• Communicate effectively with healthcare professionals.
• Respect your religious or cultural values.
• Can navigate family dynamics and mediate disagreements.

You can name more than one attorney, but it’s essential to specify whether they must act jointly or if each can make decisions independently.

For guidance on selecting an attorney, explore the Advocacy Centre for the Elderly’s resources.

Creating Your Power of Attorney Document

A valid POAPC must meet specific legal requirements in Ontario. While you can create this document independently, many people choose to consult a lawyer to ensure accuracy and compliance. The basic requirements for a POAPC include:

1. Written Documentation: The document must clearly outline your wishes and designate your attorney(s).
2. Your Signature and Date: You must sign and date the document to confirm its validity.
3. Two Witnesses: Witnesses must be present when you sign the document. They cannot be:

• Your spouse or partner.
• Your children or stepchildren.
• Your attorney or their spouse.
• Anyone under 18.

To download forms and learn more about POAPC creation, visit the Ontario Ministry of the Attorney General’s Power of Attorney Kit.

Expressing Your Healthcare Wishes

Ontario does not mandate a standard form for recording your healthcare preferences, but it is vital to provide your attorney with clear guidance. Consider the following when expressing your wishes:

Medical Interventions

• Would you want cardiopulmonary resuscitation (CPR) if your heart stops?
• Are you comfortable with mechanical ventilation if you cannot breathe on your own?
• How do you feel about feeding tubes or hydration in cases of prolonged incapacity?
• Would you prefer comfort care over aggressive treatment?

Quality of Life

Reflect on what matters most:

• "Would I want life-sustaining treatment if I couldn’t recognize my family?"
• "How important is independence in my daily activities?"
• "What role does my faith or cultural background play in my medical decisions?"

Your attorney can use this guidance to make informed decisions that align with your values. For additional help articulating your wishes, visit Advance Care Planning Canada.

The Role of Healthcare Providers

In Ontario, healthcare providers must:

• Obtain consent from your SDM for any treatment.
• Provide clear explanations of medical options.
• Respect your cultural and religious beliefs.
• Document your expressed wishes.

They cannot:

• Follow written instructions without SDM consent.
• Override decisions made by a capable patient.
• Ignore cultural or religious values that inform your care.

Learn more about the responsibilities of healthcare providers through Ontario Health.

Keeping Your Documents Accessible

Advance care planning documents are only useful if they can be easily accessed when needed. Consider the following:

1. At Home: Store the original document in a safe but accessible location, such as a fireproof box.
2. With Key People: Provide copies to your attorney(s), family doctor, and trusted family members.
3. At Your Local Hospital: Many hospitals will add advance care planning documents to your medical file upon request.

Making Changes

Life changes can affect your healthcare wishes. You can modify your POAPC at any time as long as you are mentally capable. Common reasons to update your document include:

• A new diagnosis or significant change in health.
• Changes in relationships with your attorney or family.
• Advances in medical technology.
• Moving to a new community or province.
• Evolving personal or cultural values.

For guidance on updating your POAPC, consult your lawyer or visit the Community Legal Education Ontario.

Starting the Conversation

Talking about advance care planning can be difficult, but it’s a crucial step in ensuring your wishes are respected. Use these conversation starters:

• "I’d like to talk about how I want to be cared for if I get seriously ill."
• "I need your help to make sure my wishes are followed."
• "What are your thoughts about planning for the future?"

Resources like Speak Up Ontario provide tools to help facilitate these discussions.

Taking Action: Next Steps

1. Reflect on your values and priorities for future care.
2. Discuss your thoughts with potential attorneys and family members.
3. Consult healthcare providers about medical options and their implications.
4. Create your POAPC document using legal resources or government forms.
5. Share copies with key people and store the original securely.

Finding Help

You don’t have to navigate advance care planning alone. Ontario offers various resources to assist you:

• Office of the Public Guardian and Trustee
• Community Legal Clinics
• Advance Care Planning Canada
• Advocacy Centre for the Elderly

Your family doctor can also provide medical guidance and help document your wishes in your health record.

Advance care planning in Ontario is a thoughtful and proactive way to ensure your healthcare aligns with your values. By creating a Power of Attorney for Personal Care and sharing your wishes with loved ones, you relieve your family of difficult decisions and give yourself the gift of control over your future care.

Remember, this process isn’t about predicting every possible scenario but providing a framework for informed decisions. Start the conversation today—your future self and your loved ones will thank you.

Disclaimer: This content is for informational purposes only and does not constitute professional financial, legal, or medical advice. Always consult with qualified professionals for guidance specific to your individual circumstances.