Make a Plan - Advance Care Planning Interactive Workbook

Step 1: Think

What Makes My Life Meaningful?

Learn How to Use The Workbook >

This section of the workbook will help you think about what’s important to you – and what you’d want people to know if you couldn’t speak for yourself.

Life can take many twists and turns. Imagine:
- One day, without any warning, you find yourself in a hospital with a life-threatening illness. You are unable to speak for yourself? Does anyone know your health care wishes? Who will make decisions for you?
- Your mother has slipped into a coma - and you and your siblings need to make some decisions about her medical care. Which one of you will make those decisions? How do you know if they are the right choices for your mother?
- Your father is becoming frailer as he ages. His condition seems to change every day, and he's been making regular trips to the hospital. What would happen if he couldn't make decisions for himself during the next hospital visit? Would you be able to make them for him? Would you know what to say?
- You are at the beginning stages of Alzheimer’s, and you know that at some point you will not be able to recognize people or make your own decisions. How will you make your wishes known? Who will make decisions for you?
Ask Yourself: What’s important to me?

The following questions can help you think about your values and beliefs, and what you would like others to know. You can answer as many of the questions as you like, and your answers will become part of your plan summary when you complete your Workbook.

Save & Continue Later

Step 1: Think (continued)
When I think about the end of life, I worry about:
Who can I talk to about these worries?
If I were nearing death, what would I want to make things more peaceful for me?
Choose any of these that are important to you – and add other comments if you wish.
- Family and friends nearby
- Be able to die at home
- Have spiritual support
- Having specific music played
- Having specific photos
- Other
Share additional thoughts
If possible, would I prefer to die at home, in a hospice or in the hospital? What might change my mind about my choice?
Do I have any spiritual or religious beliefs that would affect my care at the end of life? If so, what are they?
Other wishes and thoughts
Write down anything that would help others understand and support you at the end of life.

Save & Continue Later

Step 2: Learn

Familiarize Yourself with Relevant Terms

By learning more about medical terms and treatments, and legal requirements, you can make better decisions about your plan. Here are some common medical and legal terms that are important to know:

Allow natural death

Allow natural death means decisions NOT to have any treatment or procedure that will delay the moment of death. It applies only when death is about to happen from natural causes, and you would still receive treatments to keep you comfortable (e.g. pain medication, oxygen, etc.)

Cardiopulmonary resuscitation (CPR)

Cardiopulmonary resuscitation (CPR) is a medical procedure used to restart your heart and breathing when the heart and/or lungs stop working unexpectedly. CPR can range from mouth-to-mouth breathing and pumping of the chest to electric shocks that restart the heart and machines that breathe for the individual. CPR can be useful in some situations, but not in all situations.
Learn More About Making CPR Decisions

Comfort Measures

Comfort measures are treatments to keep you comfortable (for example, pain relievers, psychological support, physical care, oxygen, etc.) but not to keep you artificially alive or cure any illness.

Dialysis

Dialysis is a medical procedure that cleans your blood when your kidneys can no longer do so.

End-of-life care

End-of-life care is health care provided at the end of a person’s life. This type of care focuses on you living the way you choose during your last days or weeks.

Feeding tube

A feeding tube is a way to feed someone who can no longer swallow food.

Frailty

Frailty is a patient health state associated with getting older; involving multiple serious health issues that increase an individual’s vulnerability. Frailty can occur as the result of a range of diseases and medical conditions – even fairly minor health events can trigger major changes in a person’s health status. We usually associate frailty with noticeable losses in a person’s physical, mental or social functioning.

Hospice Palliative Care

Hospice Palliative Care is care that aims to relieve suffering and improve the quality of life. In Canada, both hospice care and palliative care are used to refer to the same thing - this specific approach to care. However, some people use hospice care to describe care that is offered in the community rather than in hospitals. Hospice palliative care strives to help patients and families: address physical, psychological, social, spiritual and practical issues, and their associated expectations, needs, hopes and fear; prepare for and manage self-determined life closure and the dying process; and cope with loss and grief during the illness and bereavement.

Intravenous (IV)

An intravenous (IV) is a way to give you ﬂuids or medicine through a vein in your hand or another part of your body.

Life support

Life support can mean medical or surgical procedures such as a feeding tube, breathing machines, kidney dialysis or CPR. All of these use artiﬁcial means to restore and/or continue life. Without them, you would die.

Organ Donation

Organ Donation is the process of surgically removing an organ or tissue from one person (the organ donor) and placing it into another person (the recipient).Transplantation is necessary because the recipient’s organ has failed or has been damaged by disease or injury. Make sure your family knows if you wish to be an organ and tissue donor. Even if you have registered as a donor, health professionals still need to ask your family for consent before recovering organs or tissue. Donation can take place only if your family consents at the time of death.
Learn More About Organ Donation in your Province/Territory

Palliative Care

Palliative Care is care that is focused on keeping you comfortable and free of pain, and may include medicine, treatments, physical care, psychological/social services and spiritual support, both for you and for those who are helping to care for you.
Learn More About Palliative Care

Power of Attorney Property / Power of Attorney Personal Care

Power of Attorney for Property / Power of Attorney for Personal Care are terms for duments where you can legally name or appoint people to act or speak on your behalf. These are witnessed documents and there may be other names they are known by in your province (e.g enduring power of attorney, mandates for incapacity, personal directives)
Learn More About Legal Requirements in Your Province/Territory

Residential Hospice

Residential Hospice is a home-like environment where adults and children with life-threatening illnesses receive end-of-life care services.

Substitute Decision Maker

A Substitute Decision Maker is a person who makes medical decisions for someone else when they cannot make decisions for themself. This person might also be known as a medical proxy, a health representative or agent or a Power of Attorney for Personal Care.
Read About Choosing a Substitute Decision Maker

Symptoms

Symptoms are signs that you are unwell - for example, pain, vomiting, loss of appetite, or high fever.

Terminal Illness

A Terminal Illness means an incurable medical condition caused by injury or disease. These are conditions that, even with life support, would end in death within weeks or months. If life support is used, the dying process takes longer.

Ventilator

A ventilator is a machine that helps people breathe when they cannot breathe on their own.

What medical care always provides:

When you are in pain or experiencing unpleasant symptoms (such as feeling dizzy or sick), health care providers will always give you medicine and treatments to relieve your symptoms.

If you reach the point where you no longer want care that prolongs your life, medical treatment and nursing care will always be given to keep you comfortable. For example, you may receive:
- Surgery to control pain
- Antibiotics
- Pain-relieving medicine
- Medication or treatments to help with breathing
Learn more about legal terms & requirements in my province/territory

Save & Continue Later

Step 3: Decide

Who Will Speak On Your Behalf?

You should decide who will make medical decisions and speak for you if you become too sick and cannot speak for yourself. Think carefully about who would be willing and able to make these decisions for you. This person will be your Substitute Decision Maker. They may be your husband or wife, or an adult child, or even a good friend.

On the next page, you will be asked to provide information about your Substitute Decision Maker.
Choosing a Substitute Decision Maker
Choosing a Substitute Decision Maker

Your substitute Decision maker will make medical decisions for you if you are unable to do so. Here are some things to consider when choosing a Substitute Decision Maker:
- Do I trust this person to make health care decisions that reflect my wishes?
- Can they communicate clearly with my health team?
- Can they make difficult decisions during stressful times?
- Is this person willing and available to speak for me if I couldn’t speak for myself?
Learn More About Choosing a Substitute Decision Maker

Legal requirements regarding who would be a substitute decision maker varies across provinces/territories. Some provinces require your to complete a specific legal form if you wish to appoint or name a SDM.

Learn About Choosing a Substitute Decision Maker in Your Province or Territory
What if I Change My Mind?

What if I Change My Mind?

Life changes, and so may your wishes and values about your health care or end-of-life care. It’s important to regularly review your wishes for future health care (advance care planning) and communication with your Substitute Decision Maker, especially if your health changes, or there’s a major change in your life.

Learn More About Important Milestones for Reviewing Your Plan

Learn More About Legal Terms & Requirements in My Province/Territory

Save & Continue Later

Step 3: Decide (continued)
You should consider who will make medical decisions and speak for you if you become too sick and cannot speak for yourself. Think carefully about who would be willing and able to make these decisions for you. This person will be your Substitute Decision Maker. They may be your husband or wife, or an adult child, or even a good friend.
My Substitute Decision Maker Is:
First Last
Relationship
Address
Street Address Address Line 2 City Province Postal Code
Phone
Email
Do you have more than one Substitute Decision Maker? Add their information here.

Save & Continue Later

Step 4: Talk

Start the Conversation

It’s time to talk to your Substitute Decision Maker, your family and your health team. These conversations may not be easy – but they will help you and your loved ones know what’s important to you.

Here are some ideas for how you can start the conversations:
Conversation Starters
Conversation Starters

There are many ways to get the conversation started! Remember, it may take a few attempts to get things started. Don’t feel like you have to have the entire conversation at once.

Be Straight Forward
- "I have just filled out a workbook about my wishes for future health care and I want to share it with you."
- "My health is good right now, but I want to talk to you about what I’d want if I was sick and needed you to make decisions for me."
Find an Example From Your Family or Friends
- "Does anyone know how Jason’s sister died? No one ever talked about it. I wonder if she died at home or in a hospital?"
- "Do you remember my friend Frank who was in a coma for a while? I wonder if there was any argument about keeping him on that ventilator?"
Blame Someone Else
- "Pastor Jones was talking about our choices for health care if something happened, and I realized that I haven’t told you about my wishes – we should talk about that."
- "My doctor wants me to think about my future care and to make an advance care plan. Will you help me?"
Find an Example From the News
- "Remember the man who was in a coma for years? I would never want that to happen to me."
- "That story about the family fighting about their mom’s care made me realize that we should talk about these things so the same thing doesn’t happen to our family."
Watch this short video to see how others have had the conversation:

Save & Continue Later

Step 4: Talk (continued)
It’s time to talk to your Substitute Decision Maker, your family and your health team about your wishes. These conversations may not be easy – but they will help you and your loved ones know what’s important to you.
Who do I want to talk to?
Who else?
- Partner/Spouse
- Child/Children
- Mom
- Dad
- Caregiver
- Doctor
- Friend
- Spiritual leader
- Other
Who else?
When is a good time to talk to them? Think about when you might approach your loved ones – for example, at a family gathering, over a meal, before my next big trip, etc.)
Where is a good place to talk? Think about where you might have the conversation – for example, at the kitchen table, at a restaurant, during a walk or drive, at the cottage, etc.)
What do I want to be sure to say? List the most important things you want to make sure you’ll talk about during your conversations:

Save & Continue Later

Step 5: Record

Write Down Your Plan

Writing down or video recording your Advance Care Plan makes it easier for others to understand what’s important to you, and to make decisions that honour your wishes if you couldn’t speak for yourself.

On the next page, you will finish creating your plan and recording of what is important to you. Don’t forget to share it with others, especially your Substitute Decision Maker.

Save & Continue Later

Step 5: Record (continued)
On the next page, you will finish creating your plan. Remember, if you have been answering questions in other sections, your answers will have been captured into your Advance Care Plan. Once you fill out this final section, you’ll be able to download your entire plan - with all of your answers - and save it to your computer.

Once you’ve made your plan, don’t forget to share it with others, especially your Substitute Decision Maker, loved ones, and health care providers. You can also take your planning documents to all medical appointments, clinic and hospital visits.
Your Name
First Last
Email
You will need to provide your e-mail address if you would like a PDF of your plan e-mailed to you
Other wishes and thoughts
Write down anything that would help others understand and support your future health care or end-of-life care.
My other planning documents:
In addition to this Advance Care Plan, I have also completed the following documents (check all that apply and note the location of each document):
- Power of Attorney (financial)
- Will
- Organ Donation
- Other (e.g. funeral plans, bequests, etc.)
Location (Power of Attorney)
Location (Will)
Location (Organ Donation)
Other (please explain)
This is the final step in completing your Advance Care Plan. Once you click on "Complete My Plan" a PDF version will be available to you as well as emailed to you if you provided your email address.

View our Privacy Policy. (This link will open in a new window for your convenience.)
Email
This field is for validation purposes and should be left unchanged.

Save & Continue Later

Step 1 of 11

Step 1: Think

What Makes My Life Meaningful?

Life can take many twists and turns. Imagine:

Ask Yourself: What’s important to me?

Step 1: Think (continued)

Step 1: Think (continued)

Step 2: Learn

Familiarize Yourself with Relevant Terms

Allow natural death

Cardiopulmonary resuscitation (CPR)

Comfort Measures

Dialysis

End-of-life care

Feeding tube

Frailty

Hospice Palliative Care

Intravenous (IV)

Life support

Organ Donation

Palliative Care

Power of Attorney Property / Power of Attorney Personal Care

Residential Hospice

Substitute Decision Maker

Symptoms

Terminal Illness

Ventilator

What medical care always provides:

Step 2: Learn (continued)

These questions can help you think a bit more about what interventions you would or would not want:

Step 3: Decide

Who Will Speak On Your Behalf?

Choosing a Substitute Decision Maker

Choosing a Substitute Decision Maker

What if I Change My Mind?

What if I Change My Mind?

Step 3: Decide (continued)

Step 4: Talk

Start the Conversation

Here are some ideas for how you can start the conversations:

Conversation Starters

Conversation Starters

Be Straight Forward

Find an Example From Your Family or Friends

Blame Someone Else

Find an Example From the News

Watch this short video to see how others have had the conversation:

Step 4: Talk (continued)

Step 5: Record

Write Down Your Plan

Step 5: Record (continued)

Step 1: Think

Step 2: Learn

Step 3: Decide

Step 4: Talk

Step 5: Record