Infographic on Advance Care Planning
This infographic explains the five steps involved in advance care planning.Read more
Our Work It Out pages offer in-depth, step-by-step guidance for dealing with a legal problem from start to finish.
Easy-to-read Need to Know pages offer tips and highlights.
This infographic explains the five steps involved in advance care planning.Read more
This infographic concisely explains representation agreements.Read more
Learn what you can do to ensure your wishes around health care and personal care are always respected.
Learn how to prepare an enhanced representation agreement, and your rights once you have one in place.
Are you preparing a representation agreement during coronavirus? There is currently a ministerial order in place temporarily allowing for the remote signing and witnessing of representation agreements. For more on what the requirements of remote witnessing are, see our information on preparing planning documents during coronavirus.
One day, you might become unable to make decisions for yourself — important decisions about your body and your health care. There’s a legal document you can sign to authorize someone to make these decisions for you. Learn how to prepare an enhanced representation agreement, and your legal rights once you have one in place.
Learn about your rights and options for changing or ending this kind of agreement.
Learn how an advance directive can be used and who should consider preparing one.
What to consider in identifying who could be temporarily appointed to make a health care decision for you.
Learn about the two types of representation agreements and the differences between them.
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Representation agreements are designed to be used when you aren’t capable of making certain decisions for yourself. There are two types of representation agreements. Learn more about your legal rights and the differences between the two types of agreements.
A representation agreement is a legal document. It lets you choose someone to help you make certain decisions — or to make decisions for you — if you’re ever incapable of making those decisions yourself. The person you choose is called your “representative.”
Under the law in BC, there are two kinds of representation agreements:
These agreements differ in three ways:
Learn more about the differences between the two types of agreements.
The law in BC says you’re capable of making an enhanced representation agreement if you can understand the nature and consequences of the proposed agreement. You must understand:
For example, your enhanced representation agreement may allow your representative to refuse life-supporting treatment. You must understand that this might happen and that, consequently, you could die.
“We just adopted a baby girl. We can’t only think about ourselves now. I decided to prepare an enhanced representation agreement. I chose my partner Max to be my representative. I know it’s a big deal to hand that much power over to him. But I can’t think of a better person to make critical medical decisions if something ever happens to me.”
– Benjamin, Vancouver
“Marta is in the early stages of Alzheimer’s. She can still make simple choices like what to eat for lunch. But basic arithmetic confuses her. When her doctor explains medical procedures, she can’t understand. Marta is no longer capable of signing an enhanced representation agreement. But in my opinion, she can sign a standard representation agreement. She can choose someone she trusts to help her make decisions.”
– Oli, Surrey (a notary public)
If you can’t legally make an enhanced representation agreement, you might still be able to make a standard representation agreement.
The law says an adult can make a standard representation agreement even if they’re not capable of any of these things:
All relevant factors need to be considered. For example, whether the adult:
Capability shouldn’t be based solely on a diagnosis or IQ. And the law says it cannot be based on the way someone communicates.
The law sorts decisions covered by representation agreements into four categories:
Standard representation agreements can cover all four types of decisions. Enhanced representation agreements can only cover health care and personal care decisions.
Under a standard representation agreement, you can give someone power to make decisions in all four areas: health care, personal care, financial affairs and legal matters (but there are restrictions on what they can do within each area). This is called giving your representative standard powers. For example:
Under an enhanced representation agreement, you can give someone enhanced powers to make decisions. This includes everything that’s covered under the standard powers, plus additional authority. But decision-making only extends to two of the four areas: health care and personal care. For example:
This Seniors First page on representation agreements has a more detailed discussion on the powers that can be given under each type of agreement.
Standard representation agreements are designed for adults who need help now, because they can’t make decisions independently. They may be appropriate for an adult:
Standard representation agreements are often used as a last resort by those who are no longer capable of making an enhanced representation agreement.
“My sister suffered a brain injury when her former partner hit her. Her doctors don’t think she’s capable of giving consent to certain medical treatment. So she made a standard representation agreement, appointing me as her representative. With it, I’m able to help keep her finances on track. I can pursue criminal charges against her former partner. I can advocate for the health care that she needs.”
– Randy, Kamloops
To learn more about your options and rights, see our page on preparing a standard representation agreement.
You can make a standard representation agreement even while you’re capable of making decisions independently.
“I don’t feel comfortable with the idea of someone refusing life-supporting care for me. Nor do I like the idea of being restrained against my will (even if I would have wanted the health care treatment if I was capable). So I signed a standard representation agreement, instead of an enhanced one.”
– Isobel, West Vancouver
“My financial affairs are simple. I receive a pension, and most of my expenses come straight out of my bank account. This includes room and board at a nursing home. I don’t own real estate. I want someone to help me with my financial affairs in the future. But I can do this with a standard representation agreement.”
– Kelly, Parksville
If you are legally capable and your financial affairs are simple, you have other options for planning too. For example, you can choose to set up a pension trusteeship. To learn more, see our page on your options for planning your financial and legal affairs.
This option is appropriate for most legally capable adults who want to have a say in their future health care and personal care. The agreement can be tailored to meet your specific needs.
Enhanced representation agreements don’t cover financial and legal matters. Most legally capable adults prepare an enduring power of attorney to plan for their financial and legal affairs.
To learn about your options and rights, see our page on preparing enhanced representation agreements.
The visuals below should help reinforce your understanding of what you’ve just read. The first visual summarizes the level of capability you need in order to prepare each type of agreement. The second visual summarizes what decision-making powers you can choose to give to your representative under each of the two types of agreements.
Learn how a MOST form facilitates a conversation with your doctor about your wishes for care.
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“My mother Alexis entered residential care last year. She expressed a general preference to receive medical attention at the care home when possible. The doctor noted this in a MOST form. When Mom got pneumonia, legally, the care home still had to check in with her about whether she wanted to be treated at the hospital. The MOST couldn’t be used as a blanket directive for her care.”
– Jeorge, Vancouver
A MOST — Medical Orders for Scope of Treatment — form is a document used in hospitals, residential care and community care settings. It should be used to facilitate a conversation with your doctor about your values and wishes for care. You may encounter a MOST when you’re chronically ill or near end-of-life, and major health care decisions are looming.
Ideally, the process should begin with an in-depth conversation between you and your doctor. If you have a representative under a representation agreement, they should be included, too. Together, you should focus on what kind of care is right for you. This should be an opportunity to discuss your values and wishes in the context of what's medically appropriate for your situation. Your doctor should complete and sign your MOST.
Here are some important things you should know about your legal rights in relation to MOSTS:
You can’t be made to have one to receive health care services.
They shouldn’t be completed or signed by you, as the patient.
For this reason, they should be used as a guide only.
Remember, a MOST should simply be used as a tool to facilitate a conversation about your wishes for care, at a particular point in time. It should not be used to unilaterally dictate your future care decisions.
So what does this mean for you? Say a medical decision needs to be made. Your doctor or care provider must follow the law of medical consent. Even if you have a MOST, they must ask you directly for your consent to medical treatment. If you’re incapable of giving it, they need to get consent from your substitute decision-maker. Otherwise, they cannot treat you. What’s written in a MOST form should never override this consent process.
Under the law, consent applies only to the specific health care treatment that an adult has consented to. Generally speaking, consent must be obtained for every health care decision, as it arises. There’s an exception for emergencies.
If you are not capable of making a health care decision for yourself, someone will have to make the decision for you.
When making health care decisions for you, the law says your representative under a representation agreement must (in this order):
A temporary substitute decision-maker is a person who will be temporarily appointed to make a specific health care decision for you. They’ll only be called on if you don’t have another authority in place that addresses the health care need. They may be called if you have a representative under a representation agreement who is not available.
When making a decision on your behalf, the decision-maker must consult with you, if possible. The law says they must also follow any wishes or instructions you expressed when you were capable.
How does a MOST fit in here? If you had a MOST conversation with your doctor when you were capable, what’s written in the MOST should represent “wishes you expressed when capable.” The decision-maker should consider these wishes, along with other any other wishes or instructions. You may have expressed in an advance care plan or to them directly.
If your wishes aren’t known, the decision-maker must give or refuse consent based on your best interests. This includes considering your current wishes, and known beliefs and values. It also includes considering the risks and benefits of the proposed health care.
This page has more in-depth coverage of temporary substitute decision-makers.
The law says that a health care provider may not always need to get your consent to provide you with treatment. This applies in emergency situations, where they need to act swiftly to save your life or prevent serious damage. And it only applies where you’re not able to give direct consent, or your representative under a representation agreement isn’t available.
However, a health care provider can’t provide you with emergency health care that’s contrary to wishes you expressed when you were capable. This would include wishes expressed in a MOST.
Talk to your doctor if your circumstances or wishes change.
We’ve outlined how MOST forms should ideally be used. This may not always be in line with how the form is used by hospitals or other care providers. It’s a good idea to get on the same page as your care providers. If a MOST is created for you, ask them to clearly explain to you how it will be used. You may want to confirm your understanding that it won’t be used as a blanket directive for care. This means that it can’t override the process of seeking consent under the law.
Refer to your local health authority for more information on the use of MOSTs in your area. There may be differences in when and how each form is used, depending on where you receive your care.