Wednesday, July 24, 2013

Advance Care Planning for Dying With Dignity

This is a terrible issue. There are three parts to Advance Care Planning to ensure that you die with dignity. While Margot Bentley created an Advance Care Plan, the long-term care believed that her signed plan was precluded by their need to care for their resident.

Here is what you should know, reprinted with permission from Wanda Morris. Visit 
1. Create an advance care plan
2. Appoint a substitute decision maker
3. Review and update it annually.

How could this be happening?

Our members and supporters have been incensed about the case of Margot Bentley, a woman in BC who has dementia and is now in an advanced state of extreme disability. Despite having taking pains to prepare a living will in which she deliberately rejected "nourishment and liquids" she is being kept alive by staff at the Maplewood Care Facility in Abbotsford who are prodding her mouth with a spoon and feeding her pureed foods in a bid to prolong her days.

In the firestorm that has erupted around this issue, one question is being repeatedly asked: How can this be legal?

Digging into the details is Professor Jocelyn Downie.  Ms. Downie is a Professor of Law and Medicine at Dalhousie University, Halifax, Canada and an eminent ethicist with interests in health law and policy, ethics and professional responsibility.  Professor Downie explores the legal issues of the case including whether Fraser Valley Health Authority does indeed have a duty of care to feed Ms. Bentley and whether in the absence of a duty of care, they have consent to do so.  See her full analysis on the Dying With Dignity blog from Impact Ethics.  

The second most common question we're hearing about the case is: How can I make sure this doesn't happen to me?  

While Margot's situation appears to be unusually unfortunate due to the ill-advised decision making of Fraser Valley Health, there are three things that Margot might have done to help her cause.  Here are three things all Canadians can do to minimize their chances of landing in Margot's shoes.  

1. Ensure you have an Advance Care Plan that reflects the latest legislation in your province or territory.  Dying With Dignity's Advance Care Planning Kits (free to all members) are specially designed to reflect the legislation in each province or territory and are an excellent resource.  Your Kit will help you reflect on your wishes, discuss them with your loved ones and most importantly, document them.  Join Now to receive yours. While Margot Bentley had written a living will, it did not include all the elements required by the Province of BC.  

2. Appoint a Substitute Decision Maker to speak for you when you cannot speak for yourself.  The appropriate form to designate this person is included in your Advance Care Planning Kit.  Margot Bentley had not appointed a Substitute Decision Maker.

3. Review, update (if necessary) and initial and date your Advance Care Plan every year.  Margot Bentley had not initialled and/or updated her plan since 1991.  Initialling and (if necessary) updating your plan every year gives added weight to your wishes by assuring health care providers that you have not recently changed your mind about your health care decisions. Why not make it a birthday habit?  Many of our members say it's the best possible present they could give themselves. 

Wanda Morris

Executive Director |  Dying With Dignity Canada

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