Making personal choices is basic to your sense of identity and well being. For health and personal care or living arrangements these decisions are especially important.
Becoming unable to make your own decisions about health and personal care can happen slowly, over time, such as with Alzheimer’s Disease; or it can happen suddenly and unexpectedly as a result of a Stroke or Accident (e.g. Slip and Fall, Adverse Medical Event or Motor Vehicle Accident).
If an illness or accident left you unable to make your own decisions, who would make those decisions for you? Would they know what you want or do not want?
Taking steps while you are capable is important so that your wishes and not someone else’s guide the decisions made for your health and personal care. This is what advance care planning is about: making it known how you wish to be cared for, and giving someone you trust the authority to act on those wishes for you, if required. This person is called your substitute decision-maker.
To be capable of making health and personal care decisions you must be able to understand the information that is relevant to making the decision and be able to understand the likely results of making the decision or not making it. This includes understanding any safety or risk issues associated with your decision or lack of decision.
For healthcare treatment, your health care provider must have your informed consent. To be able to give informed consent, you must be capable, be given information about your condition and the recommended treatment, any alternatives to the proposed treatment and the likely outcomes of either accepting or refusing the treatment.
Advance care planning gives you the opportunity to make choices about your future health and personal care. You will know that someone you trust and understands your wishes is acting on them on your behalf if you become incapable.
It is your choice whether to make an advance care plan or not. No one can do it for you or force you to make those choices. It is your right to express your wishes, to appoint a substitute decision-maker and to expect that your wishes will be followed. You are not legally required to state your wishes in any form before you can get health or personal care or move into a healthcare facility.
Advance care planning is about communicating what health and personal care you do or do not want to receive in the future to your substitute decision-maker who will make those decisions for you. Having these discussions with your family, close friends, family doctor and any other health care providers involved with you is also important.
You can change your mind and make changes about your wishes at any time. If you make changes, make sure you communicate these to your substitute decision-maker. It can be helpful for your substitute decision-maker if you put your health and personal care wishes in writing but there is no legal requirement that your choices be in writing.
In order to name someone as your substitute decision-maker, you must appoint them by making a Power of Attorney for Personal Care. Any wishes that you express about your future health and personal care take effect only when you become incapable of making the decision yourself.
A health care provider proposing the care is the person who decides whether you are capable or not of making the decision about your medical treatment, admission to a care facility or personal assistance services. This kind of assessment is ongoing, rather than a one-time event, because your ability to make decisions can vary greatly with your condition, from day to day. It can also vary depending on the complexity of the decision being made. You can be capable of some decisions and incapable of others.
For other personal care decisions you have two options, your substitute decision-maker can decide if you are capable of making the decision or not or you may prefer to have an independent assessment of you capacity with regard to personal care decisions. You can state this wish in your Power of Attorney for Personal Care. If you do this, the person you name as your attorney for personal care cannot start making decisions for you until the independent confirmation is made. In your Power of Attorney for Personal Care you can name a person close to you to provide the independent confirmation of your incapacity to make personal care decisions e.g. your family doctor. Or, you can specify a certain kind of professional, e.g. social worker. If you ask for an independent confirmation of incapacity without specifying who you would like to provide it, a professional capacity assessor will provide that independent confirmation.
You do not need a lawyer to prepare documents related to advance care planning, whether in the form of a Power of Attorney for Personal Care or “an advance care planning document”. A lawyer can however help explain your options and help prepare such documents if you wish.
Mary Gavel is the Director of Navigator & Patient Advocacy at iCare Home Health. iCare Navigator can provide assistance in answering questions about the process as well as preparation of Power of Attorney Documents. For more information on home care assistance and senior care services, contact iCare Home Health at firstname.lastname@example.org.