 On a typical day in British Columbia, over 7,000 people will go to the hospital. For many, it will be uneventful, and they'll go home the same day. For others, it will be a sudden and unexpected change to their health. And for some, it may be the last few hours or days of their life. The end of life is a difficult time. But even more so if someone is unconscious or unable to express their wishes about the care they would want to receive. Families are often unaware of the individual's wishes for health care treatment and if the person's chances of getting better or dying are uncertain, the family may be confused about whether life support or other medical interventions are the right thing to do. On September 1, 2011, British Columbia's laws were changed. Now people have more options regarding health care decisions in case they ever become incapable of expressing their wishes or deciding for themselves. This process of expressing your wishes about health care decisions ahead of time is called advanced care planning. When you need health care, the health care system will look after you. Health care treatments are based on medically appropriate choices of care. That means your doctor will assess you and offer the choices that are right for you. Advanced care planning gives you the opportunity to think about your future health care decisions and talk them over with your family and health care providers. It lets you identify which treatments you consent to or refuse based on your own beliefs, values and wishes. And if you want to choose someone in particular to make health care decisions for you, should you become incapable, you can do that with BC's new Advanced Care Planning Guide. Step 1, download the Advanced Care Planning Guide and Workbook. If you need help finding it online, call Health Link BC at 811. My voice expressing my wishes for future health care treatment is available on the seniors BC website or in hard copy from your regional health authority. You can use it to learn about advanced care planning and also to make your own advanced care plan that will serve as your voice in the future. Step 2, have family conversations about your beliefs, values and wishes. Every Advanced Care Plan starts with conversations between you and your trusted family members or friends. It may feel hard to get started, but usually the people who care about you will understand the need for these conversations. Think about the things that give your life meaning, any spiritual beliefs you may have and the values that are important to you. Talk about how sudden or chronic illness might affect your quality of life and how you might feel under different circumstances of health. I'm an athlete, physical movement is a big part of who I am. I wouldn't want to be kept alive by a machine. My life has changed a lot since my stroke, but I still have my family, a dog, getting out. Things that matter. Step 3, decide what treatments you will or won't accept and note them in the guide. It's important to think about when you might want to accept life-supporting interventions, things like breathing machines or feeding tubes. You should also think about when you might prefer not to have life-support or life-prolonging intervention. My religious beliefs don't allow me to accept lead transfusions. That's something I wouldn't do, but I would definitely accept pain relief to keep me comfortable. I have kidney disease that seems to be getting worse, but as long as I can get outside with my family, I want the doctors to keep me growing. My doctor says I have the beginnings of dementia, so I want to make my future health decisions now when I can still think for myself. What if you need healthcare and are unable to express your wishes or make decisions and you haven't named someone to make healthcare decisions for you? In that case, your healthcare provider will choose a temporary substitute decision maker from the significant people in your life. The order in which people are approached is set out in BC law. If you have a spouse, including same-sex or common law, that person will be asked to make decisions for you. If that person is unavailable or unwilling, your healthcare provider will ask any one of your children, a parent, a brother or sister, a grandparent, a grandchild, someone related to you by birth or adoption, a close friend, or someone related to you by marriage, in that order to make health decisions for you. As well as being available, the temporary substitute decision maker must be 19 or older, capable, have been in contact with you in the past year, and have no dispute with you at the time the decisions are needed. Your temporary substitute decision maker may be asked to make life-changing decisions for you, and information about your wishes in an advanced care plan can help them to make those decisions more easily. Step 4. Gather the contact information for the people on your temporary substitute decision maker list and write it down in the guide. What if you don't like the order of people to be asked on the temporary substitute decision maker list? Or what if you have many adult children? What if you would rather have your friend, not your parent, be asked to make health care decisions for you when you can't? You can choose the person you want to decide for you, but you have to name them as your representative in a legally binding document called a representation agreement so that your health care provider can ask them instead. There are two types of representation agreements in BC. The first is a standard Section 7 agreement. It's primarily for adults with lower levels of capability. A Section 7 agreement lets representatives make certain decisions about health care, personal care, and routine financial matters, but not decisions that refuse life support or life-prolonging medical interventions. An enhanced Section 9 agreement doesn't let your representative make financial decisions for you, but it does allow them to make personal care and health care decisions, including decisions to refuse life support or life-prolonging medical interventions. If you make a representation agreement, your representative's health decisions for you must be based on the instructions you wrote in your representation agreement and their knowledge of you and your wishes while you were capable. Even though I live with my partner, I think I'd pick my dad as my representative. He thinks the same way I do. I'd pick my youngest son as my representative. I know he'd honor my wishes and he talked to the other kids if a decision was needed. I've been independent all my life and I don't have any close family here. If I wouldn't want anyone else deciding for me, I'll write it down ahead of time. An advanced directive is a legal document that contains your written instructions to your health care provider about the health care you consent to or refuse in case you're incapable of deciding when the care is needed. Health care providers will not choose a temporary substitute decision maker to make decisions for you if your advanced directive has instructions about the care that is needed. An advanced directive is a legally binding document in British Columbia. You don't need a lawyer or notary public, but it must be properly signed and witnessed in order to be followed by health care providers. Similar documents created elsewhere might not be considered advanced directives in BC, but will provide an indication of your wishes. If you have no representation agreement and no advanced directive, a temporary substitute decision maker will be chosen to make health care decisions on your behalf. But remember, it will be a lot easier for your family members to make difficult decisions for you if you talk things over with them in advance and put your wishes or any specific instructions in writing. Keep in mind that your health care provider has to be able to contact someone to act as your temporary substitute decision maker, and the person chosen to be your temporary substitute decision maker has to be able to find your advanced care plan to read what's in it. Imagine if you went to all the trouble of creating a plan and it was locked away in a safe deposit box when the time came to use it. Your advanced care plan is a really important document. If you have a chronic health condition, if you engage in high-risk activities, or even if you're just marking a significant birthday, you should have an advanced care plan. Provide copies of your plan to the people who may need it. Your doctor or other health care provider, people who might be chosen as a temporary substitute decision maker for you, your representative if you named one, and keep a copy at home in an easily found location. The My Voice Advanced Care Planning Guide also has a card on the back cover that you can fill out and put in your wallet. Of course, as long as you are capable, you can change or cancel your advanced care plan. It's important that your physician and other health care providers are aware of your most up-to-date wishes and instructions about your care. The guide tells you more about this. The most important thing is to think about your wishes, start having conversations with those closest to you, and make your advanced care plan while it's on your mind. Having an advanced care plan can lessen the trauma of life-threatening situations. In writing your advanced care plan, you are easing the burden on your family if they're called on to make health care decisions on your behalf. You're giving them a gift to help them deal with a difficult time, and you're also giving yourself the comfort of knowing your wishes will be respected. In summary, you have four options available to you for advanced care planning. You can have a basic plan that simply outlines your wishes and provides a contact list of your temporary substitute decision makers. Choosing this option means a temporary substitute decision maker would be chosen to decide for you if you become incapable. You can have an advanced care plan that also includes a representation agreement where you choose and legally name the person you want to make the decisions for you. You can have a plan that also includes an advanced directive where you leave written instructions directly for your health care providers. Or you can have a plan that includes a representation agreement and an advanced directive. You'll learn more about how these options work when you read the guide. I'm writing my own advanced care plan, and I'll name a representative who knows me and my wishes well. I hope you'll do the same. No one knows what tomorrow will bring. We may enjoy good health and happiness, or we may face unexpected illness or injury. Advanced care planning helps you prepare for the future so you can fully enjoy today.