Gilmour, a specialist in health law and the legal governance of health care says, “If Terry Schiavo had had such a document (sometimes colloquially called a living will) and it applied clearly enough to the circumstances, her family would not be going through the agonizing process it is now.”

The living will is called by many names in Canada – it’s a power of attorney for personal care in Ontario – and it allows an individual to appoint a third party to make health care decisions in the case of incapacity. It can also direct, as precisely as one wishes within the law, what care an individual would and would not accept if no longer able to make decisions about health care.

Why don’t more people have a living will? Estimates are that only 15 per cent of people do. Gilmour says there are three reasons.

“First, the concept is a relatively new one. Here in Canada special powers of attorney, or advanced directives, have only been on the scene for about ten years.

“Second, a lot of people just don’t anticipate needing one. They don’t think that they will ever be at a point where they will be unable to make rational health care decisions for themselves.

“And third, it can be tough to decide what you want to put in such a document. Often one hears of people directing family members that ‘no extraordinary measures’ should be taken in the event of a debilitating illness. Who would determine what constitutes ‘extraordinary’? Is ‘do not resuscitate’ sufficient to ensure that your end is as you wish it? Or does one get very specific: no efforts to artificially feed or hydrate, no ventilator to support breathing, etc.”

If there are no written instructions, then most provinces have legislation that sets out who will be the substitute decision maker (SDM), and gives some guidance about how they should decide. In Ontario, for instance, the SDM is first to follow the person’s wishes expressed while he or she was capable, or if there are none that apply, the SDM is to decide about consenting to or refusing treatment in the person’s best interests.

“I would recommend that all Canadians at least consider the possibility of having such a document,” Gilmour concludes. “For yourselves, it’s a way to ensure that it’s your decisions about future treatment that prevail. For your families, it lets them be clear about what you would have wanted.”

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For more information, or to arrange an interview, the media should contact:

Jeff Ball, Media Relations, York University, 416-736-2100, x22086 / jball@yorku.ca

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