Planning for the End of Life

You can plan for end-of-life care

“Mom knows she doesn’t have much time left. She’d like to be at home when she dies, alongside those close to her. It's made me realize that we all have different ideas of what a ‘good death’ is. When his time came, Dad insisted he stay at the hospital. He wanted to receive any life-prolonging treatments til the very end.”

– Cameron, Lions Bay

End-of-life care describes the care someone receives as they’re approaching death. Many people will need care for days, weeks, or months before they die.  

There are many decisions to be made at the end of life. These include the kind of care you’d like and where you’d like to receive it. These decisions should reflect your values, beliefs, and wishes. 

Advance care planning is a process where you think about what you want for yourself, and share those thoughts. In BC, this may involve:

• Having conversations. Discuss your values and preferences with your health care providers, caregivers, and family. The goal is to reach a shared understanding of what matters most to you in end-of-life care.
• Preparing an advance directive. An advance directive is a legal document that records your wishes around accepting or refusing specific health care treatments. It’s most useful when someone has a specific diagnosis or is at end-of-life. 
• Choosing someone to make decisions for you. You can hand-pick a representative to guide your end-of-life care if you become mentally unable to do so yourself. You can do this by preparing a representation agreement.

You can choose the kind of care you want to receive

“I’ve been diagnosed with advanced stomach cancer. My doctor explained the treatment options: chemo and radiation, surgery, or doing nothing except pain management. I don’t want to go through with chemo or surgery. I’ve seen loved ones take this path; the side effects are brutal. I’ve decided I want to live out my last days with gratitude. This way, I can focus on what brings me joy and pleasure every day. And I want to be as comfortable as I can while doing this.”

– Pascal, North Burnaby

You have the right to choose the care you want at the end of your life. And you have the right to say no to medical treatment, even if it could prolong your life. You also have the right to stop treatment you’ve started. Talk to your doctor about each option you’re being offered. How will it impact your quality of life? What are the benefits and risks? What’s the probability of success?

You may decide you don’t want certain treatments or procedures. Be aware that you can still receive care that will manage your pain and make you comfortable. 

You should also learn about life support measures that might be offered to you as the end approaches. These include CPR, feeding tubes, and breathing machines. The BC government has a supported-decision-making tool called “Should I receive CPR and life support?” It lets you compare options and reflect on what’s important to you.

End-of-life care isn’t just about what medical treatments you’ll receive. Think about what’s important to you. Do you want a lot of people around or just a few? What makes you feel good? Would you like a massage? Are there certain comfort foods you’d like to eat? Telling loved ones what you want and need can help them care for you.

You can order that no CPR be provided

Cardiopulmonary resuscitation (CPR) is an emergency procedure that can be performed if your heart or lungs stop. Some people decide they don’t want that. 

This decision to decline emergency medical procedures can be recorded in a no CPR form. The form is a medical order. It says the person has had a conversation with a healthcare professional about CPR. It tells people such as first responders, paramedics, and care providers not to start CPR. This applies whether the person is at home, in the community, or in a care facility. 

Signing this form isn’t a decision to be made lightly. Talk to close family and friends and your doctor to see if it’s a good option for you. The answer will depend on your unique circumstances. 

The no CPR form was created by the BC Ministry of Health. There’s no law in BC that governs the creation and use of the forms. The reality is the form is widely used in the BC healthcare system, and honoured by health care providers.

You can choose where you want to receive care

Think about where you’d like to spend the last days, weeks, or months of your life. For some people, a hospital is a reassuring place to be. Others choose to be cared for at home or in a nursing home.

If you’re nearing the end of your life, you may choose to receive hospice palliative care. This approach focuses on the quality of your life rather than treatment to prolong it. Apart from medical care, you (and your family) receive emotional and spiritual support. Caregivers may also provide practical help, like running errands or fixing meals. You can receive hospice palliative care in your home or in a hospital, care home, or hospice centre.

Check if the costs of hospice palliative care will be covered by your provincial health plan or private insurance plan.

You can choose to die at home

In BC, you can plan to die at home with your family and caregivers. Your community nurse and family physician are often the best people to assist you with planning for a home death. 

If you go this route, the notification of expected death in the home form should be completed. This form authorizes the funeral home to remove your body from the home without pronouncement of death by a healthcare professional. 

Without the form, a health care professional must pronounce death before a funeral home will transport your body. 

If you, or someone you know, has a terminal illness and wants to plan for an expected death at home, see the BC government page on expected and planned home deaths.

You can consent to medical assistance in dying

Medical assistance in dying occurs when an authorized doctor or nurse practitioner helps someone end their life. This is done by providing or administering medication. 

Medical assistance in dying is legal in Canada, but it’s only available to eligible patients. This BC government page explains the criteria for eligibility. For example, you must be able to consent to the procedure. You can’t ask someone else now to authorize the procedure on your behalf at a later date, and you can’t consent to it in an advance directive. 

The BC government page also tells you who to contact to request information on medical assistance in dying, depending on where you are in BC.

You can make an organ and tissue donation

Organ donation is another important decision to consider at the end of life. Your organs can help save lives. If you haven’t already done so, you can register as a donor with the BC Organ Donor Registry administered by BC Transplant. (In BC, a decal on your driver’s licence is not an official or legal record.) 

You can specify particular organs and tissues to donate. Or you can donate your whole body, as needed —  for transplant, research, or educational purposes.

My doctor has completed a MOST form. What is it?

A MOST — Medical Order for Scope of Treatment — form is a document used in hospitals, residential care, and community care settings. It should be used to start 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. 

Legally, MOST forms do not substitute for consent. Even if you have a MOST, you must give your consent to medical treatment directly.  (There are some exceptions in emergency situations.) If you’re incapable of giving consent, health care providers need to get consent from your substitute decision-maker or your latest advance directive. Otherwise, they can’t treat you. What’s written in a MOST form should never override this consent process. 

To learn more, see our page on understanding MOST forms.