Advance care planning: wishes, not "living wills"

Gurpreet Sandhu is forty-nine, a dental hygienist in Brampton, from a Punjabi Sikh family. Her father, Harjit, is seventy-nine. He drove a truck across Canada for thirty years, and can still name every good coffee stop between here and Vancouver. Now he has a lung condition, and the stairs leave him out of breath. Whenever Gurpreet asks what he'd want if he got very sick, he asks who wants more tea.

So here's the question. How do you learn what a parent would want, when they don't want to talk about it? And what does the law actually do with those wishes?

This is general information, not legal advice. In Ontario, consent to treatment has to be informed and voluntary. Informed means the person gets what a reasonable person would need to know: what the treatment is, the benefits, the risks, the alternatives, and what happens without it. That's the law itself, Ontario's Health Care Consent Act.

When a person can no longer decide, their substitute decision-maker, the person from last lecture's ladder, gives or withholds consent for them. That person must follow a wish that applies, if it was expressed while your parent was capable. Wishes can go into a power of attorney, onto any piece of paper, or simply be said out loud. Out loud counts.

You may have heard of a living will. Ontario law doesn't use that term. People sometimes write their wishes down, and that can help, but no special form is required. Here's one useful way to see it, and it's an interpretation of how the Act works, not words from the Act: the paper names who decides, and the wishes tell them what.

One exception to know. In an emergency, a health practitioner can treat without consent in narrow conditions: when the person is suffering severely or at risk of serious harm, and waiting for consent would make that worse. So planning isn't about the emergency. It's about the many decisions after it. For help getting started, the Ontario Caregiver Organization has free advance care planning guidance.

Now, their side. Some people simply don't want to talk about dying, and that's their right. For Harjit, it may feel like bad luck, or giving up, or like his daughter already sees him as sick. It's fair to guess that asking about values is gentler than asking about machines. Try: what makes a good day for you? What would you never want to give up?

Let's change one fact. Harjit did write his wishes down, twenty years ago, long before his lung condition. Now there's a new question. A wish has to apply to the situation. Something he wrote as a healthy man of fifty-nine may not fit a slow illness at seventy-nine. Old wishes still matter, but they're a starting point for a new conversation, not the last word.

The mistake families make is thinking a form makes the decision. It doesn't. A person does, using the wishes. If no one has heard your parent's wishes, even the best-written form can't speak for them. If they have, even a wish said over dinner can guide the person who has to decide.

Here's the rule, in one breath. Know who decides, know what your parent values, and make sure those two things meet.

This week, ask one values question at dinner. Not about machines or hospitals. Just, what makes a good day for you? Listen, and later, write down what you heard.

Next time, wills basics, and how to find the important papers before anyone needs them.