Advanced Care Planning (ACP)

An advance directive is a written instruction that gives or refuses consent to health care treatment at some point in the future, in the event the adult is not capable of giving or refusing consent to treatment when it is needed. When these discussions are written down and appropriately witnessed, it becomes an advance directive.

• A power of attorney (POA) authorizes a person, called an attorney, to act for someone else in financial and legal matters. An Enduring Power of Attorney (EPOA) continues to be effective even after an adult is deemed to be incapable. The powers exercised under an enduring power of attorney end if a committee is appointed by the court and can subsequently be cancelled if the PGT is appointed by a certificate of incapability.
• In summary, a power of Attorney (POA) can be one of two forms:
  • General Power of Attorney
    • Only active when person is capable
    • Stops being active if person becomes incapable
  • Enduring Power of Attorney (EPOA)
    • Active while person is capable
    • Continues to remain active if person becomes incapable

It is important to understand that a Power of Attorney becomes invalid when the person who appointed the attorney is deemed incapable. To avoid this problem, an adult needs to make an enduring power of attorney which continues to be effective after a person is deemed incapable. An adult can use a representation agreement to appoint someone to make decisions about personal care and health care, and in the case of a representation agreement made under section 7 of the Representation Agreement Act, also about financial and legal matters. In the case of financial matters, the authority is limited to the routine management of the adult's financial affairs. This includes payment of bills, receipt and deposit of pension and other income, paying rent and other services and making some investments.

A representative is a person named by a capable adult in a legally binding document called a representation agreement. The adult may authorize the representative to make or help make health care treatment and personal care decisions on behalf of the adult at a time when the adult is incapable of making those decisions. The Representation Agreement Act outlines the various types of authority that may be given to a representative. You are not required to visit a lawyer or notary public to make a representation agreement, although you may wish to do so.

Section 7 representation agreements, or “standard” agreements have a more restricted scope of decision-making authority than Section 9 or “enhanced” agreements. Section 7 representation agreements may be used to authorize a representative to make decisions about health care treatment and personal care, the routine management of the adult’s financial affairs and obtaining legal services for the adult and instructing legal counsel. In the case of financial matters, the authority is limited to the routine management of the adult's financial affairs. This includes payment of bills, receipt and deposit of pension and other income, paying rent and other services and making some investments. Section 7 agreements do not authorize a representative to make decisions to refuse health care treatment necessary to preserve life or to physically restrain, move or manage the adult if the adult objects, or to authorize another person to do these things.

Section 9 representation agreements may be used to authorize a representative to make decisions about health care treatment and personal care. Financial and legal matters are not within the scope of a Section 9 representation agreement. Section 9 representation agreements have wider health care scope than Section 7 agreements. For example, a representative under a Section 9 agreement may make health care treatment decisions that include giving or refusing consent to health care treatment necessary to preserve life.

There are a variety of personal planning options available in British Columbia. For most adults, it is recommended that an adult obtain both (1) an enduring power of attorney and (2) a representation agreement to ensure that legal, personal, healthcare, and facility admission needs are comprehensively addressed.