Sunday, November 1, 2009

Power of Attorney - advance care planning

In Canada, it is important to get the facts about the legal requirements of ensuring that you get the medical care that you want and the protection of your property. I was at the Muskoka Elder Abuse Network* workshop. In a presentation by JoAnn Boulding, who is the Executive Director of the Muskoka Legal Aide Clinic.

Power of Attorney(POA) The Office of the Public Guardian and Trustee has produced a Power of Attorney Kit that will help you appoint the person you want to make decisions for you when you are no longer able to do so for yourself.

What is a Power of Attorney (POA)?
It is a signed, witnessed document in which you set out your wishes for the protection of you or your property.

Currently, there are two main purposes of a POA. One is for Property and the other for Personal Care. You may wish to name different people for these two separate issues.

Continuing Power of Attorney for Property

This legal document is called 'continuing' because it takes effect when you specify in the document, or when your doctor, or someone else you appointment, determines you are incapable of making decisions. Many seniors choose to give this to their children when they are unable to navigate their way to the bank, or when bill paying becomes too difficult for them. Some choose to open a joint account, if they trust that their adult child will keep their best interests at heart. Of course, in situations in the news, you will find that Elder Abuse occurs when an adult child is not making decisions in the best interests of their parent. This situation is further compounded if a parent has dementia, prohibiting them from making any rational decisions. This was my case!

I had POA both financial and personal, and the bank manager refused to accept it. Instead, she approached my father, by now exhibiting the signs of dementia: agitated, confused, unable to process numbers, or keep track of his accounts. Cognitive functioning had ceased in this area, and yet since she could not coax him into signing her bank forms, they would not grant this to me. In this situation, I should have gone to my lawyer to direct the bank manager. Their forms are not necessary. I spent hours writing his cheques for him and then dealing with the bank.

Power of Attorney for Personal Care
A legal document that gives another person the authority to make personal care decisions based on your wishes. This includes health care, nutrition, shelter, clothing, hygiene and safety. This does not mean that they can do what they want if you are incapable, but it does mean that you and your Attorney have spoken on such issues as "Do Not Resuscitate" (DNR) orders, and when to start or stop treatment.

Why do you need a POA?

Firstly, if you have an underlying condition, and extreme wishes to stay off of a ventilator, for example, you need a POA for Personal Care in order to ensure your wishes are met.

In the US it is called a 'Living Will', but this has no power in Canada. You must have prepared a POA in which you determine who would act as your Attorney, should you be unable to make decisions on your behalf.

An one site says, "Important questions that you will want to decide now, is whether you wish to prolong your life with medical treatments offered by your physician, even if such treatments may include an array of medications, surgery, or feeding tubes."

If you do not have a POA for Personal Care, and decisions need to be made, theSubstitute Decisions Act1992, S.O. 1992, c. 30, will be in force. This act specifies the various relatives from your spouse/partner, to adult children, to more distant relatives, upon whom Primary Care staff will turn to in order to create a treatment plan. That said, if you have no relatives, they will turn to the government will appoint a Public Guardian Trustee for you.

I have written of Quality of Life and End-of-life care concerns previously. Read up on what could happen. In my case, my father had unnecessary radiation and my mother's chemotherapy treatments killed her! You need to have this talk with your family, especially if you have a chronic illness, or one that threatens you on an immediate basis.

JoAnne recommends getting 6 certified copies of your POA. Also, if your children do not get along, do not appoint them together! Give the role of POA Personal Care to the one who will respect your wishes. The one who can manage money appoint them Attorney for Property. Or, appoint POA for the relative who lives the nearest to you.

Do tell your bank and your doctor about your POA. Make your decisions now, while you are able. Take control of your life and your finances. If you suspect you are being neglected, abused, or otherwise being taken advantage of, talk to the police, or your local Elder Abuse hotline.

See also my post on Advance Care Planning
If you begin caregiving for an ill family member the Ontario Government has Labour Code that provides for Employment Insurance (EICompassionate Care Benefits. Family members must be at risk of dying within 6 months, which is a little bizarre, since physicians do not like to predict death timelines and a doctor's certificate is required. But maybe that is just me!

A Guide to Advance Care Planning

by the Ontario Government Ontario Logo

Euthanasia would hurt doctors
Ottawa Citizen
... the first debate on Bill C-384, "CMA's policy on this matter is clear: 'Canadian physicians should not participate in euthanasia or assisted suicide'.

*Contact: Karen Boyer, Coordinator

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