Kingston lawyer and doctor explain the importance of advance care planning

What would happen if you were sick, so sick that you were not able to speak for yourself? Perhaps just too sick to think straight, or perhaps in the ICU – and maybe connected to a ventilator, on life support? Would your loved ones know how to speak for you and make decisions about your care? Kingston lawyer Angela Fallow advises her clients to have these difficult conversations with their appointed decision makers.

Fallow has seen what happens to families when there’s a health crisis and no clear understanding of a patient’s wishes for care. “I’ve seen family members arguing over a dying client’s bed,” she says. “Death of a loved one can be difficult enough, and each of us has the ability to make this transition easier on those around us if we can clearly articulate our future wishes for end-of-life care.”

These experiences have led her to include advance care planning resources as part of her estate planning practice, tools to help people think about what’s important to them, and to communicate their wishes to loved ones.

“Advance care planning is a process for reflecting on your future health and communicating what kind of health and personal care would be important to you. It’s also about choosing a Substitute Decision Maker – someone you trust to speak for you if you couldn’t speak for yourself,” says Fallow. “This is really important, especially if you have several family members and don’t want any misunderstandings about who would speak for you.”

A recent episode of the television show “This is Us” showed a conversation about choosing decision makers and making wishes known.  This conversation is an excellent example of successful advance care planning; all stakeholders (children) are present and Rebecca makes it clear to them who she has appointed and what her wishes are.

The pandemic has demonstrated how quickly our heath can change. Over the past two years, COVID-19 has affected both young and old at every stage of health. In many cases, families have had to make health care decisions for loved ones on ventilators. Dr. Dan Howes, a critical care physician and Fallow’s husband, sees the impact on families who are left to make decisions or decide who will speak on behalf of a family member. “It is such a difficult time for family members,” he says. “They’re worried about their loved one. If they’re also in a position of having to make critical decisions, they’re often torn between not wanting to lose their loved one and not wanting them to go through needless suffering. It is such a kindness when people take the time to talk with their family about their wishes.”

“The conversation needs to be meaningful,” says Dr. Howes. “Phrases like ‘don’t do anything heroic’ or ‘do everything reasonable’ can be very hard to interpret in the moment.” He recommends addressing a few key questions that can help a Substitute Decision-Maker  make meaningful decisions:

  1. How happy are you with the quality of your life now, before becoming sick? Quality of life rarely improves when someone is very ill and if you aren’t happy with the quality of your life now because of a chronic illness, that is important to communicate.
  2. What elements of your life are most important to you? What would you be willing to accept the loss of? Howes had one family member who expressed she would not want to continue if she wasn’t expected to be able to walk her dog each morning. It was incredibly helpful to her children when it came time for them to make difficult decisions.
  3. How accepting would you be of a new physical impairment? A new cognitive impairment? Some people feel they would be more willing to adapt to new physical challenges, but not willing to accept a severe cognitive impairment.

These are just a few of the questions that go into good advanced care planning. Compassionate Communities Kingston holds free advance care planning workshops to help people think about and have conversations about their wishes for future health care. The workshops are held at the Seniors Centre and the KFLA Public Library, and can also be arranged for groups or organizations. April 16th is National Advance Care Planning Day, a perfect time to start those conversations.

“Advance care planning has always been important, but even more so now during a pandemic,” says Fallow. “Don’t put your loved ones in the stressful situation of having to make decisions for you without knowing your wishes. Give them the gift of advance care planning.”

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