Advanced Care Planning

This involves about speaking with family and friends, especially your ‘substitute decision-maker’, and writing down your wishes. It may also include talking with health care providers, financial specialists, and legal professionals about your care choices.

An advance care plan can be written down or simply told to someone who is authorized to speak for you, such as a substitute decision-maker. It can guide your substitute decision-maker to make medical decisions on your behalf if they are asked by a health care provider.

A person who makes medical decisions on your behalf when you are not able to express your wishes on your own. This person might also be known as a health representative or a Power of Attorney for Personal Care.

A person who is legally chosen to speak on your behalf. To make it legal, you need to have a written document naming your Power of Attorney / Power of Personal Care and what their responsibilities are. If you do not select someone as your Power of Attorney, your health care team will ask the person closest to you based on a list of substitute decision-makers set by law. 

You can create a power of attorney yourself, using the free kit provided by the Ontario government. For more information, visit: http://www.attorneygeneral.jus.gov.on.ca/english/family/pgt/incapacity/poa.php

To get a Power of Attorney kit: 

Download at http://www.attorneygeneral.jus.gov.on.ca/english/family/pgt/poa.pdf

Call ServiceOntario toll free at 1-800-267-8097 to have one mailed to you.

This means that you are giving health care providers permission for medical inquiries and/or treatments. Health care providers give you detailed explanations of the inquiries/treatments and their risks before you verbally agree or sign the consent form.

This refers to medical procedures used to restart your heart and breathing when the heart and/or lungs stop working suddenly. CPR can be mouth-to-mouth breathing, pumping of the chest, electric shocks that restart the heart or machines that breathe for you.

A do-not-resuscitate (DNR) order tells medical professionals to not perform CPR. This means that doctors, nurses and emergency medical staff will not attempt emergency CPR if you stop breathing or your heartbeat stops.

This refers to care provided when you have a life-threatening illness. Palliative care is effective early in the development of illness and can be used with other therapies that may help lengthen life (e.g. chemotherapy and radiation therapy). It focuses on providing a good quality of life and keeping you as comfortable and free of pain as possible. Palliative care may involve medicines, treatments, physical care, psychological services, social services, and spiritual support. This can be provided for both you and for those who are helping to care for you. A Palliative Care Outreach Team may be involved at some time along your cancer journey.

Death and dying can be difficult subjects to think and talk about. If you are thinking about medical assistance in dying, talk to someone who can help you understand your options: a doctor, nurse practitioner or other health care provider.

You can also visit the following links for more information:

https://www.ontario.ca/page/medical-assistance-dying-and-end-life-decisions

What you can do

• Talk with your family, friends, and health care team about your wishes for treatment and medical care.
• Choose your substitute decision-maker.
• Document your wishes in a ‘Power of Attorney for Personal Care’ form. The form can be found at: http://www.attorneygeneral.jus.gov.on.ca/english/family/pgt/incapacity/poa.php
• For More Information visit the Speak Up website at http://www.advancecareplanning.ca

A Power of Attorney for Personal Care is a legal document that gives a person the right to make personal care decisions on behalf of another person. This is usually done when the person is mentally unable to make decisions with:

• Healthcare
• Shelter
• Nutrition
• Hygiene
• Clothing
• Safety

The Substitute Decisions Act (Ontario, 1996) allows you to appoint someone you trust, in advance, to make these decisions for you when you are no longer able.

The person you appoint is called your Power of Attorney for Personal Care (Attorney). It is important to choose someone who understands your beliefs and values with respect to life and health. You can appoint more than one person if you wish.

You can give your Attorney special instructions about the kind of care you want, or do not want, in certain situations.

You do not have to appoint an Attorney. This is your choice.

If you do not choose a Power of Attorney for Personal Care, the health care team that is treating you will find someone for you when you can no longer make these decisions. According to the Health Care Consent Act (Ontario, 1996), they will look to the Substitute Decision Makers list to find someone who can give consent on your behalf. The list of priority is as follows:

• Spouse or Partner
• Parent or Child (child must be 18 years or older)
• Parent having only a right of access
• Brother or Sister
• Any other relative

The following people cannot have a Power of Attorney for Personal Care:

• Family Doctor (unless they are related or partnered with the patient)
• Anyone who provides you with residential services for compensation

Choosing someone to be your Power of Attorney for Personal Care is a very serious matter. Your Attorney may need to make important decisions about your well‐being and quality of life. 

If you choose to appoint a Power of Attorney for Personal Care, it is important that you do so of your own free will and without pressure from anyone else. It is also important that you speak to the person you appoint and discuss your wishes regarding treatment and other health care matters. 

You do not need a lawyer in order to make the Power of Attorney for Personal Care legal. However, it is a good idea to talk to one.

Your lawyer can write a Power of Attorney for Personal Care, or you can buy forms from a bookstore. You can also find forms on the Internet. The Office of the Public Guardian and Trustee provides Power of Attorney forms. You can request these by calling 416‐314‐2800 or toll free at 1‐800‐366‐0335.

You can also access them online at: http://www.attorneygeneral.jus.gov.on.ca/english/family/pgt/poa.pdf

The Power of Attorney for Personal Care only becomes effective when you can no longer direct your care. This is different from the Power of Attorney for Property (finances), which sometimes becomes effective the moment you sign it, whether you are mentally capable or not.

A will is the only way to make sure that your estate (the property that you leave behind when you die) is distributed the way you want. It outlines who will get your property. You can also name the person who is responsible for following the instructions in your will and settling your estate.

This person is called the estate trustee, executor, or executrix. You should select someone you trust to carry out the terms of your will. The trustee can be a spouse, relative, friend, or a trust company. You can also choose more than one trustee in the event that your first choice is not able to act or decides not to act.

Be sure they will have your best interests at heart and will honour your wishes.

There are two kinds of wills you can use in Ontario: the formal will and the holographic will.

A lawyer usually prepares a formal will. A holographic will is one that is completely handwritten by the testator (the person who signs the will) and is prepared without a lawyer’s help.

A will does not have to be a complicated document, but it does have to be exact. Your will must be clear so that everyone understands it.

Dividing assets can be complicated and may involve many laws. Lawyers are recommended because they make certain that the law is met and that your will leaves no doubt about your wishes. 

An experienced lawyer can also help you to:

• Find possible problems with the will
• Make an informed decision regarding the person(s) you want to manage your affairs after your death
• Ensure the manner in which your estate is to be distributed.

If you have young children, you must name a guardian. The guardian is the person who will take care of your children, if the other parent is unable to care for them.

If you die without a will, the law says that you have died “in testate”. When this happens, the law says how your property is to be distributed and to whom.

The rules in the law must be followed and there are no way things can be done differently. The neediest member of the family or the person you like the most may be excluded. This may not be the most desirable outcome for your family's needs.

When you die without a will, your estate may be more complicated to settle. Without a trustee, there is more paperwork and settling your estate can take more time and money.

If you die without a will you are basically letting the Province of Ontario decide what happens with your assets, how they are shared and in what amount. It may also be necessary for someone to ask the Court to appoint them to manage your assets and deal with your affairs.

The need to put your affairs in order can cause increased stress for you and your family. Contact Supportive Care, London Regional Cancer Program at 519-685-8622

A funeral gives family and friends a chance to express their love, respect and grief. It helps people make the emotional adjustment to their loss.

Making funeral arrangements for a loved one is difficult, but it has to be done. It can be an overwhelming experience for family since many decisions related to the funeral have to be made quickly and under stress.

There are many types of funerals and burials. There are also some things that are required by law. Be sure to ask the Funeral Director what is required.

When making funeral arrangements, there are basic things that need to be arranged:

• Transportation
• Container or a casket
• Paperwork
• Burial or cremation

The following information is needed when arranging a funeral:

• Social Insurance Number of the deceased
• Date and place of birth of the deceased
• Names of parents of the deceased
• If the deceased was married, the date and place of marriage
• Names of the spouse and any children

Funeral homes offer numerous choices. The cost of the funeral depends on the services and merchandise chosen. Every Funeral Home/Cremation Service will have a price list, with a breakdown of cost for various professional services and merchandise such as caskets, vaults and urns. Prices for merchandise usually depends on the size, materials used, and craftsmanship.

Professional services provided by a Funeral Home/Cremation Service generally include:

• Making arrangements with a cemetery or crematorium
• Obtaining the necessary documents
• Transportation
• Embalming
• Visitation services
• Choice of a memorial, funeral or committal service
• Flower arrangements
• Newspaper notices

If you wish to have a funeral service, you might also think about whom you would like to conduct the service. The Funeral Director can help you with this decision.

No matter which Funeral Home/Cremation Service you choose, the important thing to remember is that buying a funeral is a business transaction like any other. Funeral costs vary depending on the options selected. That is why it is important to make these decisions at a time when emotions are not overwhelming.

Burial plots and internment services are purchased directly from the cemetery. The cemetery also provides a price list for the various burial plots, inscriptions and markers for cremation and internment services.

A ʹProof of Deathʹ certificate is an important document. It can be used to obtain benefits, bank or credit union releases, some insurance claims and other legal requirements. The Funeral Director will issue copies of the 'Proof of Death' certificate.

Needless to say, the number of choices that are available can lead to unwanted expenses in a time of emotional stress. It is good planning to make these choices ahead of time.