Canadian Health Advocates Inc. helps BC residents with their Advance Care Planning paperwork. Our Advocates have an expertise in the area of Health and Personal Planning which includes 2 important documents: Representation Agreements and Advance Directives.
Both are discussed below.
What is a Representation Agreement (RA)?
A Representation Agreement is a legally enforceable document in British Columbia and is used for Personal Planning and Advance Care Planning. It is used in cases where you need to address incapacity, end-of-life, and other support needs.
A Representation Agreement is the only way you can authorize someone – called your ‘Representative’ – to assist you or to act on your behalf for health-care and personal-care matters. You can also use a Representation Agreement to cover routine financial affairs and legal matters.
What authority can I give my Representative?
An Adult can grant wide ranging authority to their Representative under an RA, including the right to make the following decisions:
- the acceptance and refusal of health care and treatment
- decisions about where the Adult will live
- what activities the Adult will partake in
- who the Adult will associate with
- limited authority to handle basic, routine financial affairs (e.g. paying the bills, receiving and depositing income, making investment decisions, purchasing food, renting accommodation, and other services needed for personal care)
A Representative must always act in accordance with the Adult’s wishes. When it comes to decisions regarding lifesaving medical intervention, this might not always be akin to the Adult’s best interests.
It is important that the Adult and Representative have in-depth conversations about the Adult’s desires with respect to their personal and medical care. It is important to have these conversations while the Adult has the capacity to express those wishes.
Who should I appoint as my Representative?
Most people appoint a spouse or partner, family member, or friend as their Representative. Your Representative doesn’t need to live in the same city, province, or even country as you.
However, there are some restrictions on who you can appoint. You cannot appoint someone who is compensated to provide health- or personal-care services to you (e.g. a paid caregiver). This includes an employee of a facility where you live if the facility provides health or personal care services to you. These restrictions do not apply if the person is your spouse, parent, or child.
There are a number of factors to consider when choosing who to involve in your Representation Agreement, such as your trust in them, their skills and abilities, and their understanding of your wishes and values.
What happens if I need a Representation Agreement and don’t have one?
A crisis can happen at any time, so it is important to be prepared.
If you are rendered incapable as a result of an illness or accident and do not have an RA, the Health Care (Consent) and Care Facility (Admission) Act (BC) determines who your medical-care providers must contact as your substitute decision maker. The list is as follows (in order):
- Anyone else related by blood or adoption
- Close friend
- Any person immediately related to you by marriage
In order for a person to be a suitable decision maker, they must be 19 years of age, capable, willing, have had contact with you during the previous 12 months, and not be in a dispute with you.
If you have specific desires with respect to medical treatment and personal care, an RA gives you the opportunity to express those wishes clearly and in a manner that binds your Representative.
Can I Choose an Alternative Representative?
Yes. You can choose one or more alternative representatives who can act in place of your first representative if he or she becomes unwilling or unable to act for any reason. If you name an alternative representative, you must specify in your agreement the circumstances in which your alternative is permitted to act as your representative.
Are there Different Types of Representation Agreements?
Yes. Under the BC Representation Agreement Act (the “Act”), there are two different types:
- RA7: This is an agreement with only “limited powers” – sometimes called a section 7 representation agreement.
- RA9: This is an agreement that includes “general powers” – sometimes called a section 9 representation agreement.
|For Adult 19yrs or older||For Adult 19yrs or older|
|NEED HELP TODAY||NEED HELP IN THE FUTURE|
|Need assistance with decision making and/or managing with affairs||Able to make decisions independently on own and manage own affairs|
|"Limited Powers"||"General Powers"|
|Covers all 4 life areas but limited...Health Care, Personal Care,Financial, Legal||Covers ONLY Health and Personal Care Matters|
|For people that are unable to have an Enduring POA||For people that are able to appoint an Enduring POA|
The agreement you choose to make depends on your mental capability at the time of the agreement.
Do I need a lawyer or notary public to do my RA?
No, the BC legislature wants the making of Representation Agreements to be accessible.
Where do I get the forms for my RA?
You can get simplified instructions on filling out your Representation Agreement here.
Do I also need an Enduring Power of Attorney (EPOA)?
Yes. An Enduring Power of Attorney is the necessary counterpart to an RA9. An RA9 is only for dealing with your personal-care and health-care needs. The authority to deal with financial affairs is very limited. In order to fully protect yourself should you become incapacitated, you will require an Enduring Power of Attorney. CHAI Advocates can help direct you to the appropriate resources to ensure your EPOA is completed properly.
ADVANCE DIRECTIVES (AD)
An Advance Directive must directly apply to health-care decisions as well as being readily interpretable into Medical Orders for Scope of Treatment (MOST).
You do not need a lawyer to prepare an AD, but your AD must meet certain guidelines.
ADs have replaced Living Wills, which were never legal in BC.
You should consider an AD in the following circumstances:
- You have been diagnosed with a life-limiting or life-ending illness.
- You don’t want to, or feel you can’t, discuss your End-of-Life wishes with family and friends.
- Your substitute decision makers are not easy to reach by phone and/or will have to travel a great distance and/or it will be a burden for them.
- You do not have a family doctor you feel is responsive to having a discussion of this type.
- You’re a planner by nature and you’d rather be safe than sorry.
For more information:
Printable form with examples of Advance Directives:
MOST (Medical Orders for Scope of Treatment)
Difficult conversations: Why they’re important
Conversations about your wishes and Advanced Directives reduce conflict between health-care professionals and temporary substitute decision makers (TSDMs).
Talking about these issues before we get sick helps our family members know what decisions to make during a time of stress and crisis. Having these discussions is a gift to your family.