How do you make sure your wishes are heard and respected when you can't speak for yourself? In BC, the answer comes down to two sets of documents: ones that define your choices about care, and ones that assign someone to make decisions on your behalf.
Three documents let you pre-define your care 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. Two good starting points are Advance Care Planning BC and the Advance Care Plan Forms guide, which includes RA7, RA9, TDSM and EPOA templates.
Medical Orders for Scope of Treatment (MOST)
A MOST form is completed by your clinician in consultation with you or your designated representative to define the healthcare treatments you consent to. You can see the form here: Medical Order for Scope of Treatment (MOST).
No-CPR Form
A No-CPR form, also called a Do Not Resuscitate (DNR) form, is a medical order used to decline CPR in the event of a cardiac or respiratory event. The No Cardiopulmonary Resuscitation (No CPR) Medical Order pre-dates the MOST document and remains legally valid, but the MOST form is more detailed and generally preferable.
Assigning Your Representatives
Four documents can determine who will be legally empowered to make decisions for you before a court has to decide.
An Enduring Power of Attorney (EPOA) gives another individual the right to make decisions about your life, health, and finances. It is the greatest grant of authority you can give. A Representation Agreement Section 9 (RA9) gives someone the ability to make health decisions including over life and death, but not finances. A Representation Agreement Section 7 (RA7) covers routine financials and routine health care, but not life-and-death decisions. A Temporary Substitute Decision Maker (TSDM) can step in when one of your other assigned representatives is not available, covering daily living and routine health care, which can include through life and death.
If none of these documents exist and no representative has been pre-determined, the court will assign the BC Public Guardian & Trustee or find a Temporary Substitute Decision Maker who meets the legal definition.
Rights of Legal Representatives
Different representatives carry different powers. Life support covers decisions that impact your life-and-death healthcare, including advanced life support. Health care covers non-life-and-death treatment decisions. Daily living covers your residence and related arrangements. Routine financials cover bill payments and supervision of services with financial impact. Major financials cover the sale of a home or other major assets. Legal affairs covers signing contracts and agreements.
This table shows which representatives hold which powers:
| Type of Legal Representative | Life Support | Health Care | Daily Living | Routine Financial | Major Financial | Legal Affairs |
|---|---|---|---|---|---|---|
| Public Guardian & Trustee | Yes | Yes | Yes | Yes | Yes | Yes |
| Private Trustee** | Yes | Yes | Yes | Yes | Yes | Yes |
| Enduring Power of Attorney (EPOA) | No | No | No | Yes | Yes | Yes |
| Regular Power of Attorney (POA) | No | No | No | Yes | No | No |
| Representation Agreement (RA9) | Yes | Yes | Yes | No | No | No |
| Representation Agreement (RA7) | No | Yes | Yes | Yes | No | No |
| Temporary Substitute Decision Maker (TSDM) | Yes | Yes | Yes | No | No | No |
**Private Trustees require a 'Committee of Person' document to be charged with Life Support and Health Care decisions, and a 'Property Guardian' document to be charged with Major Financial decisions.
A Note on Spousal Medical Records
A spouse does not automatically get access to their partner's medical records. They still need a Representation Agreement or POA. Get this done ahead of time so it's not a problem in the moment.
Who will do for us as we would do for ourselves?
Simple question, hard answer. You can define your choices with Advance Directives and a MOST form, but the people you give legal power are not legally bound to follow those documents to the letter. Choose representatives you trust to honour your written wishes.
It is also possible for your RA7 or RA9 Representative to challenge your Power of Attorney in court using your estate's resources if they disagree. Completed Advance Directives and MOST forms help avoid that mess.
If you are unsure whether you need a lawyer, contact Nidus or Seniors First BC. Both are BC non-profits offering free advice on advance care planning and representation.