Advance Care Planning: Machines Keeping You Alive or Not?

When I was in private practice and assisting clients with their estate planning, we would often discuss their advance care planning. The discussions inevitably lead to 95% of my clients saying, “I don’t want to be kept alive by machines.” Some had strong and well researched views while others made this statement without deeply considering the circumstances in which a “machine” may be beneficial for their possible but yet unknown medical emergency. With a global pandemic upon us, we have all heard about patients being kept alive by ventilators. Ventilators are machines that move air into and out of your lungs when you are not able. Ventilators are the life support machines that many of my clients said they didn’t want.

Ventilators are not simple oxygen masks that are placed over your mouth. When a patient is put on a ventilator, they are often medically sedated and strapped down. A feeding tube will provide nutrients to the patient; this tube is typically inserted into the nose or a hole is made in the stomach. You will not be going to the bathroom on your own and you will not be having conversations with your family members while you are on a ventilator. You will not even know you are on a ventilator.

If your views have changed about being kept alive by machines, then you may want to update your Advance Care Planning documents and inform your family members. In many jurisdictions, you may legally appoint someone you trust to make medical and personal decisions for you when you are not able to. In British Columbia, the document is called a Representation Agreement and your Substitute Decision Maker is called a “Representative”. It is a similar to a Power of Attorney for Property (which I’ve discussed on a previous post) but instead of your Substitute Decision Maker making legal and financial decisions for you, a Representative makes medical and personal care decisions for you. This document is often called something different depending on where you live; such as Power of Attorney for Personal Care. And your Substitute Decision Maker may go by different titles as well.

I recommend that you do some research before you decide who to appoint as your Substitute Decision Maker for health care. Ideally, it is someone you absolutely trust and who is level-headed in an emergency. Think about your personal family circumstances.

• Do your spouse and children get along?
• Will the person(s) you appoint be able to manage the stress and act responsibly when tasked with making critical health care decisions for you?
• Is there someone you absolutely do NOT want to act and speak on your behalf?
• Have you discussed your wishes in detail with your Substitute Decision Maker?
• If you are not comfortable discussing your views and wishes with your appointed Substitute Decision Maker, then is this the right person?

Advance Care Planning is more than just appointing your Substitute Decision Maker. The Canadian Hospice Palliative Care Association (CHPCA) and the Nidus Personal Planning Resource Centre (Nidus) have resources to assist you. Nidus also has free sample Representation Agreements which may be used in British Columbia, and CHPCA has created an Advance Care Planning Toolkit (Workbook) for the public.

Your local provincial or state governments should also have resources available for you. As always, everyone’s personal situation is different and if appointing a Substitute Decision Maker is important, you should do your research and seek professional legal advice in your area.

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