Advance Care Planning

Let's start with learning about the Advance Care Planning (ACP) Process.

  • ACP are conversations that help you and your Substitute Decision-Maker (SDM) prepare for future healthcare decisions.
  • It is important to prepare your SDM because there may come a time when you are unable to make your own healthcare decisions.
  • As long as you are mentally capable you will continue to make your own healthcare decisions. However, sometimes people cannot make their own decisions because they are too sick or unconscious (not awake). This could be during surgery, from an accident or due to an illness. If you recover and become mentally capable again, you will make hour own decisions.

For example:

Althea has a bladder infection that spread to her kidneys. Because of this severe infection she is very confused and is temporarily incapable of making her healthcare decisions.

Priya has advanced Alzheimer's disease and is unable to safely live at home. After she was found incapable, her daughters consented to her admission to a Long-term care facility.

During her breast cancer surgery, Tran will be sedated and unconscious. Because she is temporarily incapable, her SDM will be asked to consent if decisions must be made.



If Althea, Priya and Tran have had Advance Care Planning conversations with their SDMs, it can help them make decisions during these times. 



What else do I need to know about ACP?

  • ACP is about preparing you and your SDM for future healthcare situations and decisions.
  • Advance Care Planning is not just about preparing for end-of-life. It is about planning for any healthcare needs you may have in the future.
  • ACP occurs through conversations you have with your SDM, your family, friends and healthcare providers. 
  • ACP is a way for your SDM to learn how to make decisions for you if you are not able to make them yourself.
  • You cannot know what future healthcare decisions you may face, but you do know what quality of life means to you and what values and wishes help you with making health care decisions. Your SDM(s) needs to know this too.
  • If you are not ready to have a conversation about your values and wishes that’s ok. This website also gives you information to help you identify who would be your SDM(s).
  • Before any treatment can be started, healthcare providers must get consent.
  • If you are capable you will make your own decisions. But if you are incapable your SDM will decide what to do. If your capacity returns, then once again you will make your own healthcare decisions.
  • Healthcare providers must talk to a person, they cannot get consent from a piece of paper.
  • Writing down your thoughts and wishes can be helpful for your SDM to read before making a decision.
  • This is why involving your SDM in ACP and helping them understand your values and wishes is so important.



Learn about what it means to be mentally capable and when your SDM might be asked to make your healthcare decisions

See how ACP works for a variety of different people and circumstances 



How does ACP relate to my future healthcare?

  • ACP helps prepare you and your SDM for healthcare decisions that happen in the future.
  • To give consent for care or treatments you need the details of your current condition and the treatment options. In the planning stages, some of the details you need to make decisions are missing. 
  • If you get sick and a decision needs to be made, you will have a goals of care conversation. This is where you will get details you need to make a healthcare decision.
  • A goals of care conversation includes talking about what treatment options fit best with your values and goals.
  • If you lose capacity to make healthcare decisions, sharing information about your values and goals will help your SDM in these future conversations.
  • Prepare today for decision making in the future.  




Frequently Asked Questions

What is Advance Care Planning?

  • Advance Care Planning (ACP) is a way for a person and/or their SDM to prepare for future health care needs.
  • It is a series of conversations.
  • ACP is NOT consent for any treatments that are in the future.

Why is ACP important?

  • ACP is a way to help you prepare for your future health care needs
    • Learning about your illnesses
    • Identifying your substitute decision-maker
    • Thinking about your priorities and values about your health
  • ACP helps your substitute decision-maker learn more about your health issues, values and priorities in case they need to make decisions for you in the future
  • ACP prepares your SDM(s) to give consent for treatments in the future if you are NOT mentally capable.
  • ACP conversations you have today will make it easier for your SDM(s) in the future so they don’t have to guess at your wishes in the middle of a difficult time.
  • ACP can decrease the burden and stress experienced by your SDM

Can I do ACP even if I don't have an SDM?

  • Everyone in Ontario automatically has an SDM
  • If there are no relatives or appointed SDMs, the Public Guardian and Trustee (PGT) will act as SDM if someone is not capable of making healthcare decisions.
  • A person can choose to have ACP conversations with their healthcare providers, to share their values and wishes.
  • Healthcare provider can share this information with the PGT if they have to make healthcare decisions 

How will my SDM make decisions if I have not had any ACP conversations?

  • If your wishes are not known, your SDM(s) must act in your “best interests.”
  • “Best interests” has a specific meaning in law: your SDM must consider a person's values and beliefs.
  • They would also consider:
    • Your health condition
    • If you are likely to improve, remain the same or deteriorate without the treatment
    • The risks and benefits of the treatment options

Should I include my SDM in ACP conversations?

  • It is good idea to involve your SDM as much as possible in these conversations.
  • ACP is meant to prepare your SDM to make your healthcare decisions in the future if you loses capacity to make your own decisions.
  • If you are not comfortable including your SDM in ACP conversations, think if there is  someone else you would prefer in the role.
  • Your SDM may have to make some hard choices. Knowing about the person and their values can make this easier. 

What if I change my mind after I write down my wishes?

  • Advance Care Planning is a process and a person can always change their mind.
  • In Ontario, it is the most recent wishes that your SDM(s) should consider when they make a decision.
  • Things you tell an SDM are just as important as what you put in writing. The most recent is the one that's important. 
  • For example if you write down something today and then tell your SDM something different in a month, those are the wishes they need to consider.

Does my SDM have to follow my wishes?

  • Your SDM must look at any wishes you made when you were  mentally capable.
  • Your SDM must ask themselves two questions:

1) Do they apply to the current decision?

2) Are they possible to follow?

  • SDMs do not have to follow a wish that is impossible to honour.
  • There are many things that can make a wish impossible to honour. Decisions will depend on the person's health and care needs, finances and the number of people around who can help care for a person.
  • For example, a person may tell an SDM that they wish to remain at home but there may be times when a hospital or long-term care is the best place to receive care based on the person's needs.



Start your ACP journey today