Imagine for a moment that you get sick. Not just with a cold, or something else temporary, but a long-term, life-limiting or life-ending issue illness. How do you make sure you are properly cared for, especially if you can’t speak for yourself?
Who will your nurses and doctors listen to, if you’re not able to give them directions?
Think about the people who are in your life right now. Who would you choose to take on that task? Who would know you well enough to be able to step in for you and give direction to your health care providers and caregivers?
Most people, when asked this question answer some version of “my family knows what I want”, or “of course, my spouse will do that for me”.
That’s great, but who do you mean when you say “my family”?
Who is your family?
Family means so many different things to so many people. And just because you might happen to have certain people in your life doesn’t mean those people are the right people to have help you with your personal care and health care.
Should we be listening to your spouse? What happens if your spouse is just as scared or confused as you are? Or if they faint at the sight of blood? What if your spouse is incapable? What if your spouse is someone you met and married two weeks ago in Las Vegas?
If you have children, which of your children should we listen to – the one who shows up first? The loudest one? The one who you haven’t seen for 5 years?
What happens when your kids don’t get along with your new spouse?
What happens if your spouse, your kids and your sister all show up in the hospital? And start arguing about who has the right to speak?
What happens if you want your best friend to make these decisions for you, and not anyone in your family?
You can see that this can turn into a mess very easily. Who should your health care providers listen to when this happens?
Getting informed consent
Your health care providers need to get something called informed consent from you before they can treat you.
That informed consent might come from you, or it might come from some other source.
Getting informed consent from you
Informed consent means that you understand your specific medical situation, that you have been given proper information about your options, that you have had a chance to ask questions, that the treatment proposed is appropriate for the situation at hand, that there is no fraud happening, that you are consenting voluntarily, and that you have the necessary legal capacity to consent to the proposed treatment.
That’s a lot, and might not be possible, depending on the situation.
If you can give informed consent on your own behalf, then you will do that. But if you can’t give informed consent, and you need treatment, what happens next?
Getting informed consent from someone else
The law tells us how to proceed when we can’t get informed consent directly from you. The law is detailed, and complicated.
If a health care provider thinks that you need health care, and that you can’t consent to that care yourself, your health care provider can:
- ask your representative (a person you have named in a representation agreement to consent for you)
- if you don’t have a representative, and:
- your life is in danger, your health care provider must get a second opinion that this care is needed
- your health care provider can find a temporary substitute decision maker, they can ask that temporary substitute decision maker to provide consent for certain kinds of health care (but not ALL health care)
Determining expressed wishes
If you can give informed consent for yourself, then you can tell your health care providers if you have any specific wishes about health care.
We call these specific wishes expressed wishes, because you must express them to your health care providers so they can act on them.
For example, maybe you:
- are allergic to certain drugs or ingredients
- have specific religious beliefs about health care (no blood products? don’t want organ donations? or amputations? how about assisted suicide?)
- have cultural beliefs about health care (you want to be treated at home? you want only alternative kinds of treatments)
If your health care provider knows that you have these kinds of wishes, then they must follow these wishes.
You might have made this easy for your health care providers by putting a “no blood products” card in your wallet, or wearing a Medic-Alert bracelet setting out restrictions or needs for care.
You might also have done nothing to let others know of these issues, and that means your health care providers will proceed without this information.
Making a Representation Agreement
So there is, of course a better way than simply leaving all of this up to your family and your health care providers to sort out in the middle of an emergency.
In BC, you can make a document called a Representation Agreement. Sometimes people call this document a “Power of Attorney for Health Care”, but the proper name in BC is a Representation Agreement.
This document names the people you want to help you, and sets out any specific wishes you might have for your care.
It gives your people the power they need to speak to your health care providers on your behalf, and it lets your health care providers know who they can rely on for decisions.
There are two different kinds of representation agreements:
- Section 7 Representation Agreements give routine powers (but not a full range of powers) over health care, personal care and financial affairs, and are usually made by people who have limited capacity
- Section 9 Representation Agreements give a full range of powers for health care and personal care, and no powers for financial affairs; these documents are made by people who have legal capacity, and are usually paired with a Power of Attorney for financial affairs.
Let us help you make a Representation Agreement, so everyone knows who to listen to, and you get the care you truly want.May 19, 2019 1:38 pm
Tags: expressed wishes, health care, personal care, Power of Attorney, Representation Agreement, treatment plan