Powers of Attorney Substitute decision maker is the person to whom a patient has given the legal authority to speak on their behalf should the patient be unable to communicate for themselves. This would typically be the main family caregiver. You get formal acceptance as the substitute decision maker by having your loved one sign a Power of Attorney for Personal Care form and a Power of Attorney for Property. Everyone should have these Powers of Attorney in place. These legal documents provide the hospital, financial institutions, and the courts with a person who can make decisions on behalf of the patient should the patient be unconscious, incapable of communication or mentally incompetent to make decisions. A lawyer can write up the form or you can use the provincial Ministry of the Attorney General’s standard form available through its booklet: Office of the Public Guardian and Trustee. (2007). Powers of Attorney and “Living Wills.” Queen’s Printer for Ontario. 21-page document at: http://www.attorneygeneral.jus.gov.on.ca/english/family/pgt/poa.pdf The Ministry also has a helpful brief “Question and Answer” guide to answer the most common questions at: http://www.attorneygeneral.jus.gov.on.ca/english/family/pgt/livingwillqa.pdf Some things to consider: You or the person signing these forms for you may want to set a time limit on some of the specific treatment instructions. For example, if you instruct your power of attorney to allow the healthcare team to try any and all treatment options to keep you alive, you may add the time limit of three months (or any time period). If after that time, you are unable to speak for yourself and your attorney and the medical care team all agree that any further treatment is hopeless, they would give their attorney the authority to stop all (or some — depending on the person) treatments and life-sustaining efforts. This prevents, for many people, having life-support treatments go on for months or years. You or your attorney may include that you want, or do not want, a Do Not Resuscitate order in their medical file to be changed only with the consent of their power of attorney (i.e., no unilateral decision by healthcare providers). If they appoint more than one power of attorney, they can decide whether they must agree on all decisions or whether either can decide for them. They may chose the second option if, for example, their two children travel a lot and only one is likely to be nearby to make decisions on their behalf. What happens if your loved one does not have a signed Power of Attorney? Typically the immediate family is asked to make healthcare decisions on the loved one’s behalf. If there is conflict within the family, hospital staff may bring in a social worker or mediator to help resolve the conflict re: decision making. If that does not work, one or more family members or friends may apply to become the patient’s guardian. The government, through the Office of the Public Guardian and Trustee (OPGT), acts only in situations where no other suitable person is available, able and willing. DNR versus Full Stat Orders A doctor may ask for a Do Not Resuscitate (DNR) order to be added to a patient’s chart. This would mean that if the patient has a heart attack, a respiratory arrest or similar life-threatening event, the hospital staff would not try to resuscitate them. If there is no DNR in place, the hospital is required to try to resuscitate the patient. Sometimes a DNR is put in the chart without a patient’s permission. If a patient wants the hospital staff to try and resuscitate them in these circumstances, they, or their power of attorney should ask to make sure that there is not a DNR order in the person’s file. If there is one, insist that it be removed with a note in the chart that the patient or their power of attorney for personal care has asked that it be removed. A conditional DNR order is one that says that if the patient has a heart attack that is not witnessed by anyone, that resuscitation not be tried. Resuscitation in such circumstances fails 100 percent of the time. Lastly, CPR in frail and elderly people may cause bones, and in particular, ribs to break. This could lead to very painful and difficult recovery, if recovery is possible at all. Discuss the probable consequences of CPR, related specifically to your loved one’s health condition. Full Stat In some jurisdictions, putting the words “FULL STAT” on the outside of a person’s medical file gives a directive that is the exact opposite of DNR (do not resuscitate) and, therefore, might be a safeguarding measure for people who might be very vulnerable to medical practitioners wondering how far to go. FULL STAT means to go full out, or to fully implement all reasonable measures to ensure life. As a reminder, you may wish to type or write these words in large black letters on the cover page of this Binder. Different provinces, territories, and foreign countries have different regulations concerning how someone can legally delegate someone else to speak for them if they ever become legally unable to speak for themselves. For example, if you are in an accident and can’t speak, you can have a legal document that says that your spouse, parent, or best friend can make decisions on your behalf.

Powers of Attorney

Substitute decision maker is the person to whom a patient has given the legal authority to speak on their behalf should the patient be unable to communicate for themselves. This would typically be the main family caregiver. You get formal acceptance as the substitute decision maker by having your loved one sign a Power of Attorney for Personal Care form and a Power of Attorney for Property.

Everyone should have these Powers of Attorney in place. These legal documents provide the hospital, financial institutions, and the courts with a person who can make decisions on behalf of the patient should the patient be unconscious, incapable of communication or mentally incompetent to make decisions.

A lawyer can write up the form or you can use the provincial Ministry of the Attorney General’s standard form available through its booklet:

Office of the Public Guardian and Trustee. (2007). Powers of Attorney and “Living Wills.” Queen’s Printer for Ontario. 21-page document at:

http://www.attorneygeneral.jus.gov.on.ca/english/family/pgt/poa.pdf

The Ministry also has a helpful brief “Question and Answer” guide to answer the most common questions at:

http://www.attorneygeneral.jus.gov.on.ca/english/family/pgt/livingwillqa.pdf

Some things to consider:

•You or the person signing these forms for you may want to set a time limit on some of the specific treatment instructions. For example, if you instruct your power of attorney to allow the healthcare team to try any and all treatment options to keep you alive, you may add the time limit of three months (or any time period). If after that time, you are unable to speak for yourself and your attorney and the medical care team all agree that any further treatment is hopeless, they would give their attorney the authority to stop all (or some — depending on the person) treatments and life-sustaining efforts. This prevents, for many people, having life-support treatments go on for months or years.
•You or your attorney may include that you want, or do not want, a Do Not Resuscitate order in their medical file to be changed only with the consent of their power of attorney (i.e., no unilateral decision by healthcare providers).
•If they appoint more than one power of attorney, they can decide whether they must agree on all decisions or whether either can decide for them. They may chose the second option if, for example, their two children travel a lot and only one is likely to be nearby to make decisions on their behalf.
•What happens if your loved one does not have a signed Power of Attorney? Typically the immediate family is asked to make healthcare decisions on the loved one’s behalf. If there is conflict within the family, hospital staff may bring in a social worker or mediator to help resolve the conflict re: decision making.
•If that does not work, one or more family members or friends may apply to become the patient’s guardian. The government, through the Office of the Public Guardian and Trustee (OPGT), acts only in situations where no other suitable person is available, able and willing.

DNR versus Full Stat Orders

•A doctor may ask for a Do Not Resuscitate (DNR) order to be added to a patient’s chart. This would mean that if the patient has a heart attack, a respiratory arrest or similar life-threatening event, the hospital staff would not try to resuscitate them.
•If there is no DNR in place, the hospital is required to try to resuscitate the patient.
•Sometimes a DNR is put in the chart without a patient’s permission. If a patient wants the hospital staff to try and resuscitate them in these circumstances, they, or their power of attorney should ask to make sure that there is not a DNR order in the person’s file. If there is one, insist that it be removed with a note in the chart that the patient or their power of attorney for personal care has asked that it be removed.
•A conditional DNR order is one that says that if the patient has a heart attack that is not witnessed by anyone, that resuscitation not be tried. Resuscitation in such circumstances fails 100 percent of the time.
•Lastly, CPR in frail and elderly people may cause bones, and in particular, ribs to break. This could lead to very painful and difficult recovery, if recovery is possible at all. Discuss the probable consequences of CPR, related specifically to your loved one’s health condition.

Full Stat

In some jurisdictions, putting the words “FULL STAT” on the outside of a person’s medical file gives a directive that is the exact opposite of DNR (do not resuscitate) and, therefore, might be a safeguarding measure for people who might be very vulnerable to medical practitioners wondering how far to go. FULL STAT means to go full out, or to fully implement all reasonable measures to ensure life. As a reminder, you may wish to type or write these words in large black letters on the cover page of this Binder.

Different provinces, territories, and foreign countries have different regulations concerning how someone can legally delegate someone else to speak for them if they ever become legally unable to speak for themselves. For example, if you are in an accident and can’t speak, you can have a legal document that says that your spouse, parent, or best friend can make decisions on your behalf.

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