Support for Caregivers of Older Adults
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Advance Directives (Personal Directive)

 
 Overview    ↓ next top ↑
  • There are several different kinds of directives, such as an advance directive, a living will, etc. It is important to note that only a personal directive is legally recognized in the Province of Alberta.
  • A personal directive is a legal document. It states a person's wishes about non-financial decisions, including medical care, when they can no longer make the decisions on their own.
  • A personal directive includes the name of an "agent", a substitute decision maker, who has the authority to make these non-financial decisions.
  • Your family member needs to share their feelings on life, illness, and death as well as their wishes about end-of-life care with the agent and, if appropriate, with other family members.
  • A lawyer can be, but is not required to be, involved in creating personal directives. Sample forms and instructions for their completion are available from the Office of the Public Guardian (see Resources).
  • An Enduring Power of Attorney may also be needed to assist with financial decisions.
 
 Introduction    ↓ next top ↑
  • When adults are healthy and able to think clearly, they should consider setting up a personal directive and Enduring Power of Attorney for future planning and to express their wishes for their care.
  • Personal directives are legal documents that allow people to state what they would want done about non-financial matters, including medical and personal care, in the case of terminal illness, dementia, coma, or stroke.
  • These documents make it easier for family and friends to make non-financial and personal decisions when the person can no longer do so.
  • The documents also help the health care team recommend treatments that match the person's wishes.
  • Many caregivers have said that a personal directive helped them a great deal when treatment decisions needed to be made. These documents represented their family member's interests when discussing health care and other decisions with the health care team, and helped reduce the stress associated with emotionally difficult decisions.
  • Personal directives also help older people feel confident that future medical decisions will be based on their values, wishes and beliefs.
 
 What You Should Know    ↓ next top ↑
 
 Personal Directives 
  • A personal directive is a voluntary document. You do not need a lawyer to make a personal directive. There are legal requirements for a personal directive to be valid. Sample forms are available from the Office of the Public Guardian (see Resources).
  • A personal directive states a person's wishes about personal, non-financial matters including medical care. It is used if, at some time in the future, the person is unable to make decisions about non-financial matters. The personal directive includes the name of someone (an "agent") who has the authority to make these decisions.
  • A copy of the personal directive should go to the agent and the family physician. The personal directive should also be included in the medical record if the older person is admitted to a hospital or a long-term care facility. This way, health care staff will know what the patient's wishes are if he or she cannot speak.
 
 Selecting an Agent    ↓ next top ↑
  • All adults should discuss their wishes and their personal directives with their family members or those closest to them. They should choose someone to make non-financial and medical decisions if, in the future, they were unable to do so. This person is called an "agent," which means someone who has the authority to act for another person.
  • The older person can identify their agent in their personal directive.
  • Older people usually select a family member or a close friend as an agent. The agent should be someone the older person trusts to make the right decision or choices for him or her. Be sure that the person selected feels comfortable serving as an agent.
 
 Issues to Discuss    ↓ next top ↑

Your family member needs to share their feelings on life, illness, and death as well as their wishes about care with the agent and, if appropriate, with other family members.

They should discuss questions such as the following:
  • Would the person want to receive artificial nutrition at the end of life? Would they want to be on a respirator (breathing machine) if they were unlikely to recover or in a permanent coma?
  • What illness or permanent disability would be unacceptable to the older person? If they had a terminal illness, would they want medical treatments to prolong life or only medicines to remain comfortable?
  • What medical treatments would not be wanted under any circumstances, even if the treatment were used temporarily?
  • What medical treatments are acceptable on a temporary basis to help recover from an illness, but would not be acceptable permanently?
 
 Enduring Power of Attorney    ↓ next top ↑
  • Similar arrangements should be made for financial affairs via an Enduring Power of Attorney. A trusted caregiver, such as a family member or friend, can be chosen to assist with financial decisions. This allows the designated caregiver, known as the "attorney", to make decisions about financial matters or property on the family member's behalf while that person is still alive but unable to make such decisions on their own.
  • The Enduring Power of Attorney is a separate legal document and is not part of the personal directive.
  • If there is a significant estate or if there is family discord, this should be prepared with the help of a lawyer. However, in clearer situations, standard templates can be used.
 
 Guardianship and Trusteeship    ↓ next top ↑
  • Guardianship and trusteeship come into play when someone is no longer capable of making independent decisions and there are no advance directives, such as a personal directive and Enduring Power of Attorney, in place. When this situation occurs, guardianship and/or trusteeship must be obtained through the courts.
  • Assistance is available from social work agencies for families who need to make these types of arrangements.
 
 Capacity    ↓ next top ↑
  • The concept of "capacity" – whether or not a person is capable of making decisions -- is domain specific and question specific. For example, a diagnosis of dementia does not automatically mean lack of capacity. A person with dementia may retain the ability to make personal decisions until well into their illness, but lose their financial reasoning quite early, or vice versa.
  • Generally speaking, people with dementia retain their ability to name an agent well into the illness. However, this is not always the case, so advance planning is always the better option. A physician or psychologist trained in capacity assessment will be able to give you an opinion on whether your family member is still capable.
 
 See Also    ↓ next top ↑

While the content of each Caregiver College Topic may be linked to a variety of other Topic areas, the following has been identified as a Key Linkage which you may be interested in also reviewing:
 
 Resources  top ↑

Government of Alberta
  • Office of the Public Guardian: Sample personal directive forms, directions on how to complete the forms and frequently asked questions are provided.
  • What is a Personal Directive in Alberta?: The Provincial Health Ethics Network provides links to information about Personal Directives, including legislation, FAQs and two publications that can be accessed online or sent to you for free.
Alberta JusticeLaw Society of Alberta
  • Lawyer Referral Service, which assists people in finding a lawyer in Alberta.
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