Your Choices & Decision Makers

Your Choices & Assigned Representatives

How can you make sure your decisions will be heard and respected if you have no voice of your own? Three documents can be used to pre-define your choices: Advance Directives, Medical Orders for Scope of Treatment (MOST) and No-CPR Forms.

Advance Directives

Advance Directives define the scope of health care treatments you would consent to or refuse.

• Advance Care Planning BC
• Advance Care Plan Forms (includes RA7, RA9, TDSM and EPOA)

Medical Orders for Scope of Treatment (MOST)

MOST forms are completed by your clinician in consultation with you or your designated representative to define healthcare treatments you consent to.

• Medical Order for Scope of Treatment (MOST)

No-CPR Form

No-CPR forms, also known as Do Not Resuscitate (DNR) forms, are medical orders used to decline CPR in the event of a medical event.

• No Cardiopulmonary Resuscitation (No CPR) - Medical Order (This form pre-dates the MOST document and remains legally valid. The MOST form is more detailed and preferable.)

To protect your choices in BC there are legal documents to Define Your Choices, the boundaries of your consent to various health procedures, while others Assign Your Representatives, defining the conditions and Powers given to your Representatives when making decisions for you.

Powers given to your Representatives

Life Support   

Make decisions that impact your life and death healthcare including advanced life support

Health Care     

Make decisions that impact your non-life and death healthcare

Daily Living     

Make decisions about your daily living circumstances, residence and related arrangements

Routine Financials     

Make decisions about routine bill payments and supervision for changes to services with financial impact

Major Financials     

Make decisions about the sale of a home or other major assets

Legal Affairs     

Make decisions and sign for legal contracts and agreements

Assigning Your Representatives

Four documents can determine who will be legally empowered to make decisions for you before the courts have to determine the appropriate representative.

Enduring Power of Attorney (EPOA)

gives another individual the right to make decisions about your life, health and finances. This is the greatest grant of authority that can be bestowed.

Representation Agreement Section 9 (RA9)

gives another individual the ability to make health decisions including over life and death but not finances.

Representation Agreement Section 7 (RA7)

gives another individual the ability to make decisions for routine financials and routine health care but not including over life and death.

Temporary Substitute Decision Maker (TSDM) List

When one of your other assigned representatives is not available a TSDM may be assigned to make decisions about daily living, routine health care which may include through life and death. 

Court-Decided

When none of these documents are completed and no representative has been pre-determined the court will assign the BC Public Guardian & Trustee or find a Temporary Substitute Decision Maker that meets the definition.

Assigning Your Legal Rights

This table lists the different types of legal representative in Canada and your legal rights given to each type of representative. [wpdatatable id=1] **Private Trustees require a 'Comittee of Person' document to be charged with Life Support and Healthcare decisions. **Private Trustees requre a 'Property Guardian' document to be charged with Major Financial decisions.

Important Note for Spousal Medical Records

For a spouse to access their partner’s medical records they still require a Representation Agreement or POA. Make sure this is completed ahead of time to avoid problems in the moment.

Who will do for us as we would do for ourselves? 

A simple but difficult question. You can define your choices using the advance directives and MOST form but the individuals you select with legal power to make choices for you are not beholden to follow those documents to the letter. It is critical to ensure that the people chosen as your representatives are people you can trust to follow your written directions and wishes for yourself. It is possible for your Representative (RA7 or RA9) to take your Power of Attorney (POA) to court using your estates resources if they disagree. Having completed Advance Directives and MOST forms can help avoid this situation. If you are uncertain whether you need a lawyer please contact Nidus or Seniors First BC; both are BC non-profits who offer free advice on legal issues around advance care planning and representation.

• Nidus
• Seniors First BC