End-of-life plans: Is it too morbid to plan your death?
‘This is also life. You can’t plan for everything. That’s just part of the natural chaos’
Todd Hooge has a new son and a thriving Victoria tech-firm, but the recent death of a friend with a terminal illness got him planning ahead for his own demise, to protect his partner from being left with gut-wrenching decisions.
"I've had people close to me have to pull the plug on their parents and that was not pretty," said Hooge, 47, who said he is eager to spare loved ones from that burden.
A year after Canadian law changed to permit assisted dying in extreme situations, interest is exploding in end-of-life planning as greying baby boomers seek more control over their final days, legal experts say.
More than 8,500 people in B.C. have registered advance-care health and personal planning documents with Nidus, a free legal planning registry in B.C. In addition, Death with Dignity workshops have seen attendance double this year, say organizers.
"We like to see people well before they require these documents," said notary public David Watts. "It's a bit like insurance. Once you need it … you might be too late to get it. You need to have full mental capacity to understand what you are doing. Get on it right away."
But there's no guarantee that some pre-death planning instructions will be honoured under current Canadian laws.
Hooge's friend was a healthy 70-year-old who suddenly fell ill with cancer. The disease killed him within months. The man wanted a medically-assisted death, but that could not be honoured because he was too medicated to be considered lucid enough to make that decision. His death was eased only by painkillers.
In Canada, a person must be considered mentally competent to be considered for a medically-assisted death. They must also be facing a reasonably foreseeable death so they can't pre-plan a medically assisted death while they are still healthy.
Some advocates are pushing for further changes to the federal assisted dying law that would permit people to make plans affecting end-of-life decisions while they're still healthy. These type of arrangements are already permitted in the Netherlands
In some Canadian provinces, such as Ontario, Quebec and Nova Scotia, living wills are an option to provide end-of-life instructions. But when Hooge went to a lawyer's office draw up such a document, he was shocked to learn that living wills don't exist in B.C.
Seek other tools
In the absence of living wills and with pre-planned deaths not permitted in Canada, many B.C. residents are seeking other legal tools to help define how their medical care and death will be handled.
Lawyers stress that these tools cannot be used to pre-plan a medically-assisted death in Canada.
Under current assisted dying legislation, a medically assisted death can only be granted if the individual is older than 18 and meets four stipulations.
Those stipulations include: The person must have a serious incurable illness, disease or disability; they be in an advanced state of decline; be experiencing intolerable physical and psychological suffering; and their natural death must be reasonably foreseeable.
Lawyers say existing legal tools can define how your end-of-life care is administered.
Three documents are advised for end-of-life planning in B.C., including a representation agreement, an advanced medical directive and an enduring power of attorney.
A representation agreement names two people who will help make decisions about your health or medical care, in a situation where you cannot. Choose people who will respect your wishes as they will speak for you.
Lawyers also recommend preparing an enduring power of attorney for financial matters and an advanced directive that advises medical staff — or your representatives — about specific medical scenarios, such as whether or not you want to be kept alive by artificial means or resuscitation.
"[A representation agreement] is your best safeguard," says Susan Hughson, director of Dying with Dignity Canada. Hughson registered her documents with Nidus and keeps a second copy at home.
She said a person can use tools like representation agreements combined with medical directives to outline specific instructions regarding end-of-life medical care, such as resuscitation, intubation or feeding. Instructions on these issues could "hasten" death legally, she said.
"I've done the best I can and hopefully this will be honoured. This is also life. You can't plan for everything. That's just part of the natural chaos," she said.