What to include in your plan
- Record of your wishes
- Temporary substitute decision makers list
- Conversation starters
- Representation agreement
- Advance directive
- Medical orders (No CPR Form & MOST)
Essential Information to Include
A record of what you thought and talked about – your values, beliefs, and wishes for health and personal care.
My Wishes, My Care: Thinking it Through
A step-by-step guide to help you think about and record what matters most to you – your values, beliefs and wishes for future health care and personal care. This guide can help you create a written or audio/video record of what matters most to you.
A list of people who might be asked to make health-care decisions for you when needed.
Temporary Substitute Decision Maker Contact List
A template to help you record the contact information of your potential temporary substitute decision makers. You can include notes on who does not qualify and why.
To qualify, the person must:
• be 19 years of age or older,
• capable of making decisions,
• have no dispute with you, and
• have been in contact with you in the past year.
Conversations are key… in fact talking about your values, beliefs, and wishes for future care with the people you trust is the most important part of advance care planning (yes, even more important than making a plan!). Our conversation starters can help get the ball rolling.
Optional Documents You Can Include
A legal form you can make to appoint your own substitute decision maker.
What you need to know about standard representation agreements (section 7)
What you need to know about enhanced representation agreements (section 9)
Guide to the Enhanced Representation Agreement form (section 9) provided by the B.C. government.
Medical orders your health-care provider can make to record your wishes.
No CPR Form
A medical order signed by you and a doctor or nurse practitioner to refuse cardiopulmonary resuscitation (CPR).
MOST (Medical Orders for Scope of Treatment)
A medical order completed by a doctor or nurse practitioner to record what level care you wish to receive.
✓ Store your plan in a safe place where it can be easily located if needed (e.g. on your fridge).
✓ Share your plan with the people you trust and your health-care providers.
✓ Review your plan at regular intervals and when anything changes.
✓ Advance care planning isn’t a one-time event!
This initiative is supported by funding from Public Health Agency of Canada. The views expressed herein do not necessarily represent the views of Public Health Agency of Canada. Cette initiative bénéficie du soutien de l’Agence de la santé publique du Canada. Les opinions qui y sont exprimées ne représentent pas nécessairement les positions de l’Agence de la santé publique du Canada.