PLANNING FOR END OF LIFE CARE
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Transcript of PLANNING FOR END OF LIFE CARE
PLANNING FOR END OF LIFE CARE
Heather WestawayRegistered Kinesologist Manager, Health Sciences and Interprofessional EducationNorthern Ontario School of [email protected]
Lori Rietze BScN, MSN, PhD (c)
Registered Nurse Faculty, Laurentian University
learn strategies to support yourconversations about end of life
care
6-8pmR.H. MURRAY SCHOOLWhitefish, Ontario
Sponsored by the Whitefish District Lions Club
JOIN US MAY 20 2014
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. BREAK9. 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
Are you able to
appreciate the reasonably
foreseeable consequences of a decision
or lack of decision.
The health care provider who proposes a treatment is
required to form an
opinion about your capacity
to provide consent
Hierarchy of Substitute Decision Makers – HCCA, 1996
5
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
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 orderd) Availablee) Willing
“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…”
“Well then what is a Power of Attorney?”
How would the person making decisions for me know what
treatments I would have wanted?
Treatment Decision by the Substitute Decision Maker
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
Is the treatment likely to
improve my condition or well-being?
What are my
expressed wishes
when I am capable?
Expressed Wishes = Advance Care Planning w SDM, when capable, in advance of hospitalization, at home
Treatment Decisions = Goals of Care w doctor in hospital, in the moment
Advance care planning can
inform Goals of Care
Conversations
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
How will I make decisions about my care
at End-of-life?
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 NOTAdvance 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.caAdvocacy 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?