What are representation agreements and advance directives?

This article looks at what advance directives and representation agreements are in British Columbia.

Planning for the care one will receive if one becomes incapacitated in the future can be a difficult decision. However, planning for future contingencies is not only responsible, it can also help protect loved ones from having to make difficult decisions based on poor information. Many people have very strong opinions about the type of care they expect to receive if an accident or medical emergency leaves them incapable of making their own decisions. As HealthLinkBC points out, it is important to discuss with loved ones and set out in writing the type of health care that one expects in the event that one is left incapable of consenting to or refusing certain types of care and treatment. Advance directives and representation agreements are two important documents for ensuring one's wishes can be respected in the future.

What is an advance directive?

An advance directive is a legally binding document that allows a capable adult to direct a health care provider or representative in what kind of health care and treatment the adult either consents to or refuses. If an adult has an advance directive and becomes incapable of making his or her own care and treatment decisions, then health care providers can use the advance directive to ensure that whatever care or treatment is provided complies with the patient's wishes. To be legally enforceable, any instructions laid out in an advance directive must be in compliance with the law. Furthermore, a health care provider or representative may choose to not follow an advance directive in a limited number of cases, such as if the directive was made involuntarily or through fraud or if medical knowledge has advanced since the directive was written and which may provide benefits to the patient.

What is a representation agreement?

As the British Columbia Ministry of Health points out, if an adult patient becomes incapable of making his or her own care and treatment decisions, then a capable adult will have to make those decisions on his or her behalf. If a patient does not have a representation agreement, then in most cases a health care provider will choose a temporary substitute decision maker (TSDM) who can make care-related decisions for the patient. In the majority of cases, the TSDM is a family member, such as a spouse or child.

Alternatively, a capable adult may choose to create a representation agreement so he or she can choose who will be able to make those health care, financial, and legal decisions if he or she is incapable of doing so. Representation agreements are divided into Section 7 and Section 9 agreements. Section 7 agreements allow an adult to name a representative who can make limited decisions concerning the adult's health care and treatment, along with some financial and legal decisions, on the adult's behalf. While a Section 9 agreement does not cover financial or legal decisions, it is broader in scope than a Section 7 agreement in terms of health care. A Section 9 agreement, for example, may allow a representative to make life-and-death care and treatment decisions that are in accordance with the patient's wishes.

Planning for the future

Advance directives and representation agreements are important documents that can have major ramifications on one's future health care. These documents must be in full compliance with the law, however, to be enforceable. A wills and estates lawyer should be contacted by anyone who has questions or concerns about their own advance care planning.