1. PLANNING FOR END OF LIFE CARE Heather Westaway Registered Kinesologist Manager, Health Sciences and Interprofessional Education Northern Ontario School of Medicine hwestaway@nosm.ca Lori Rietze BScN, MSN, PhD (c) Registered Nurse Faculty, Laurentian University lrietze@laurentian.ca learn strategies to support your conversations about end of life care 6-8pm R.H. MURRAY SCHOOL Whitefish, Ontario Sponsored by the Whitefish District Lions Club JOIN US MAY 20 2014 http://www.advancecareplanning.ca/health-care-professionals/videos.aspx

2. 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. BREAK 9. 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?

3. 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

4. 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

5. 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

6. 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 order d) Available e) Willing

7. “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?”

8. 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?

9. 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

10. 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?

11. 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.

12. So, What is NOT Advance 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

13. Why is Advance Care Planning important?

14. 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

15. How do I start Advance Care Planning?

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17. 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.

18. 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

19. Wallet card p. 39

20. Where can I get more Information? SPEAK UP: www.Advancecareplanning.cawww.Advancecareplanning.ca Advocacy Centre for the Elderly: www.acelaw.cawww.acelaw.ca

21. 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

22. QUESTIONS?