Understanding Medical Decisions in Your Advance Directive: A Canadian Guide to Making Informed Choices

Creating an advance care plan requires careful thought about your values, beliefs, and what matters most to you in different healthcare scenarios.

This guide will help you think through the major medical decisions you'll need to address in your advance care plan, with specific questions to help you clarify your preferences within the Canadian healthcare context.

Life-Sustaining Treatments and Resuscitation

When considering life-sustaining treatments, it's important to understand that these decisions go beyond simple yes or no choices. Think of these decisions as defining the circumstances under which you would want different levels of intervention.

Questions to Consider About Life Support

Think about your preferences in different scenarios:

"Under what circumstances would you want to be placed on a ventilator?"

• If recovery is likely but will take time?
• If there's uncertainty about the outcome?
• If permanent ventilator support might be needed?
• If there's severe brain damage but consciousness remains?
• If the chance of recovery is low but exists?

"How long would you want to try life support before transitioning to comfort care?"

• A specific time period?
• Until certain medical criteria are met?
• Until family members can gather?
• Until specific events occur?
• As long as there's any hope of recovery?

CPR Decisions

Consider these questions about resuscitation:

"In what situations would you want CPR attempted?"

• During a sudden, unexpected event?
• If you have a terminal illness?
• If you have severe dementia?
• If you're already seriously ill?
• If full recovery isn't likely?

"What level of disability would you be willing to accept after CPR?"

• Need for nursing home care?
• Dependency for daily activities?
• Cognitive impairment?
• Physical limitations?
• Quality of life impact?

Artificial Nutrition and Hydration

Decisions about artificial feeding and hydration often cause significant anxiety for families. Clear guidance in your advance care plan can help prevent this distress.

Questions About Tube Feeding

Consider these scenarios and questions:

"Under what circumstances would you want artificial nutrition?"

• After a stroke with swallowing difficulties?
• During recovery from a serious illness?
• With progressive neurological disease?
• In late-stage dementia?
• As a bridge to recovery?

"What factors should guide decisions about continuing or stopping artificial nutrition?"

• Quality of life considerations?
• Likelihood of recovery?
• Comfort level?
• Religious beliefs?
• Family impact?

Hydration Decisions

Think about your preferences for artificial hydration:

"When would you want to receive IV fluids?"

• During short-term illness?
• In end-stage disease?
• For comfort measures?
• During the dying process?
• To prolong life?

Organ and Tissue Donation

Organ donation decisions involve multiple considerations within the Canadian system. Understanding your options helps you make informed choices.

Questions About Organ Donation

Consider these aspects:

"What type of donation would you consider?"

• Organs for transplant?
• Tissues for transplant?
• Body donation for medical education?
• Research purposes?
• Specific organs only?

"What are your preferences regarding donation procedures?"

• How long to maintain life support for donation?
• Which organs you're willing to donate?
• Religious or cultural considerations?
• Research participation?
• Family involvement in the process?

Pain Management and Comfort Care

Clear instructions about pain management can significantly impact your care quality.

Questions About Pain Control

Think about these scenarios:

"What are your preferences for pain management?"

• Maximum pain control even if consciousness is reduced?
• Balance between pain control and alertness?
• Natural remedies versus medications?
• Experimental pain treatments?
• Alternative therapies?

"How would you balance comfort versus longevity?"

• Prioritize comfort over life extension?
• Accept some discomfort for longer life?
• Prefer maximum alertness?
• Cultural practices for pain management?
• Spiritual considerations?

Experimental Treatments and Clinical Trials

Consider your willingness to participate in medical research or try experimental treatments.

Questions About Medical Research

Think about these aspects:

"Under what circumstances would you participate in research?"

• If standard treatments fail?
• To help advance medical knowledge?
• Only if personal benefit is possible?
• For specific conditions only?
• With what level of risk?

Medical Tests and Procedures

Consider your preferences for diagnostic procedures in different situations.

Questions About Medical Testing

Think through these scenarios:

"What diagnostic procedures would you accept?"

• Invasive testing methods?
• Tests that require anesthesia?
• Procedures with significant risks?
• Tests that won't change treatment?
• Genetic testing?

Implementing Your Decisions

Once you've thought through these questions, consider how to document your choices effectively:

Documentation Considerations

• Use clear, specific language.
• Provide context for decisions.
• Include reasoning behind choices.
• Address common scenarios.
• Allow flexibility when appropriate.

Regular Review Process

• Schedule periodic reviews.
• Update after health changes.
• Revise with new medical information.
• Adjust based on experience.
• Communicate changes to all parties.

Taking time to think carefully about these medical decisions helps ensure your advance care plan truly reflects your wishes. Remember that these decisions aren't just about medical procedures – they're about your values, beliefs, and what matters most to you in healthcare situations.

Consider discussing these questions with your healthcare providers to ensure you understand the medical implications of different choices. Your family and substitute decision-maker should also understand your reasoning to help them advocate effectively for your wishes.

Disclaimer: This guide provides general information about medical decisions in advance care planning. Specific options and requirements vary by province and healthcare setting. Consult with healthcare providers and legal professionals for guidance tailored to your situation.