PLANNING FOR END OF LIFE CARE

Heather WestawayRegistered Kinesologist Manager, Health Sciences and Interprofessional EducationNorthern Ontario School of Medicinehwestaway@nosm.ca

Lori Rietze BScN, MSN, PhD (c)

Registered Nurse Faculty, Laurentian University

lrietze@laurentian.ca

learn strategies to support your

conversations about end of life care

6-8pmR.H. MURRAY SCHOOLWhitefish, Ontario

Sponsored by the Whitefish District Lions Club

JOIN US MAY 20 2014

http://www.advancecareplanning.ca/health-care-professionals/videos.aspx

Objectives for tonight:1. Who will make decisions for me if I am not capable of making

them myself?

2. How will the person making decisions for me know what I would have wanted?

3. What is Advance Care Planning?

4. Why is Advance Care Planning Important?

5. How do I start Advance Care Planning?

6. What are Goals of Care?

7. How do I start Goals of Care Conversations?

8. BREAK

9. What will happen if I don’t have Advance Care Planning discussions with my family, friends and healthcare providers?

10. Where can I find more information?

Who will make decisions for me

if I am not capable of making

them myself?

1.Your doctor must inform you that you are not capable of making your own decisions

2. Your doctor must get consent for all treatments from your substitute decision maker

Are you able to understand the

information that is relevant to making a

decision about the treatment, admission, or personal assistance

service

Are you able to appreciate the

reasonably foreseeable

consequences of a decision or lack of

decision.

The health care provider who

proposes a treatment is required to form an

opinion about your capacity to provide

consent

Hierarchy of Substitute Decision Makers – HCCA, 1996

5

1. Guardian of person

2. Attorney in Power of Attorney for Personal Care

3. Representative appointed by Consent and Capacity Board

4. Spouse or partner

5. Child or Parent or CAS (right of custody)

6. Parent with right of access

7. Brother or sister

8. Any other relative

9. Office of the Public Guardian and Trustee

Requirements to ACT as Substitute Decision Maker

The person highest in the hierarchy may give or refuse consent only if he or she is:

a) Capable

b) At least 16 years old

c) No court order or separation order

d) Available

e) Willing

“A Power of Attorney for Personal Care is a document through which you appoint your

substitute decision-maker and give them the power to make decisions about all aspects

of your personal care… health care, shelter, clothing (etc.)… only used if you become

incapable…”

“Well then what is a Power of Attorney?”

How would the person making decisions for me know what

treatments I would have wanted?

Treatment Decision by the Substitute Decision Maker

Is the treatment likely to improve my condition or

well-being?

What are my expressed

wishes when I am capable?

Treatment Decision by the Substitute Decision Maker

Is the treatment likely to improve my condition or

well-being?

What are my expressed wishes

when I am capable?

Expressed Wishes = Advance Care Planning w SDM, when capable, in advance of hospitalization, at home

Treatment Decisions = Goals of Care w

doctor in hospital, in the moment

Advance care planning can

inform Goals of Care

Conversations

Advance care

planning

• ongoing process of discussing, formalizing, and updating a person’s preferences and wishes for the end of life

• to guide substitute decision makers in making decisions about care should you become incapacitated

Goals of Care

• consent of particular treatment such as resuscitation or artificial ventilation

• with you if you are capable or your substitute decision maker if your are incapable

How will I make decisions about my care

at End-of-life?

So, What is Advance Care Planning then?

Advance care planning is ongoing expressions general values and wishes about how you wish to be cared for in the future. These conversations are held between you and your substitute decision maker when you are not in hospital and while you are still capable.

So, What is NOTAdvance Care Planning

then?• One conversation• A consent to treatments (not

generally helpful)• A refusal of medical treatments

(not generally helpful)• A document or checklist to be

completed• Wishes that are NOT shared with

your SDM

Why is Advance Care Planning important?

Benefits of Advance Care Planning

Your wishes are more likely to be respected

a sense of control over your treatments

Quality of life and death

stress on substitute decision maker

conflict among your family members and friends

Medical over or under treatment (suffering)

unwanted hospitalization

How do I start Advance Care Planning?

Page 16

So, what are Goals of Care then?

Goals of care conversations are discussions about consent to treatments. These conversations are held between you and your doctor or your substitute decision maker and your doctor when you are in hospital.

How will I start Goals of Care Conversations?

1. Make a list of any illnesses that you have (heart failure, dementia, cancer…)

2. Ask your doctor about your illness progression and trajectory

3. Ask your doctor about potential end of life treatments

4. Continue to ask questions about these treatments until you understand your options, risks and benefits

5. Communicate your treatment decisions to your substitute decision maker and your doctor

Wallet card p. 39

Where can I get more Information?

SPEAK UP: www.Advancecareplanning.caAdvocacy Centre for the Elderly: www.acelaw.ca

Thank you

Judith Wahl, B.A., LL.B for her contribution to the content in this

project and for her ongoing support.

The Whitefish District Lions Club

QUESTIONS?