PLANNING FOR END OF LIFE CARE
learn strategies to support your
conversations about end of life care
JOIN US MAY 20 2014
6-8pm
R.H. MURRAY SCHOOL
Whitefish, Ontario
Lori Rietze
Heather Westaway
Registered Kinesologist
Manager, Health Sciences and Interprofessional
Education
Northern Ontario School of Medicine
hwestaway@nosm.ca
BScN, MSN, PhD (c)
Registered Nurse
Faculty, Laurentian University
lrietze@laurentian.ca
Sponsored by the
Whitefish District Lions Club
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
The health care
provider who
proposes a
treatment is
required to form
an opinion about
your capacity to
provide consent
Are you able to
appreciate the
reasonably
foreseeable
consequences of a
decision or lack of
decision.
Hierarchy of
Substitute Decision Makers –
HCCA, 1996
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
5
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
“Well then what is a Power of
Attorney?”
“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…”
How would the person making decisions for
me know what treatments I would have
wanted?
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
Expressed Wishes = Advance Care Planning w SDM, when
capable, in advance of hospitalization, at home
Advance care
planning can
inform Goals of
Care
Conversations
Is the
treatment
likely to
improve my
condition or
well-being?
What are my
expressed
wishes when I
am capable?
Treatment Decisions = Goals of Care w
Treatment Decision by the
doctor in hospital, in
Substitute Decision Maker
the moment
How will I make decisions about
my care at End-of-life?
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
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 NOT
Advance 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.ca
Advocacy 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?