Advance Care Planning

Frequently Asked Questions

ACP & Personal Directives

Click on any of the questions below to see the answer.

Is this advance care planning initiative an Alberta Health Services - Calgary and area program only or is advance care planning being implemented elsewhere?
Is a lawyer required to complete a "My Voice" workbook and the attached Personal Directive?
What is the duty of an Alberta Health Services - Calgary and area staff member to comply with a personal directive?
What is the correct course of action if a patient's verbal wishes contradict what they had written earlier in their "My Voice" workbook of personal directive (PD)?
Is it permitted for an Alberta Health Services staff member to witness the signing of a Personal Directive?
Is it permitted for an Alberta Health Services - Calgary and area staff member to be named as an agent for a patient or client?
Does the Advance Care Planning: Goals of Care Designation (Adult) policy require the completion of the "My Voice" workbook? My patient has a Personal Directive (PD), an Enduring Power of Attorney and a will that were drawn up by her lawyer. She and her family feel that everything has been attended to and are reluctant to consider any additional documentation.
Can the "My Voice" workbook be completed if an existing PD has been activated?
How important is it for my patient to complete the "My Voice" workbook and a personal directive (PD) if they have already talked with their families and everyone seems to be in agreement?
How will the "My Voice" workbook and the Goals of Care Designations inform the care of an individual who must access health care outside the Alberta Health Region - Calgary and area boundaries, in Alberta or another province?
The person I am caring for already has an Enduring Power of Attorney (EPOA) document. When they ask about the need to complete a "My Voice" workbook and a Personal Directive (PD), what should I tell them?

ANSWERS

Is this advance care planning initiative an Alberta Health Services - Calgary and area program only or is advance care planning being implemented elsewhere?
The AHS – Calgary area launched work related to advance care planning in the spring of 2005. The initial work focused on developing advance care planning resources using five pilot groups within the Region. In January, 2006, a charter was approved to develop a policy that would provide a regional framework for determining goals of care using the advance care planning processes and resources to support decision-making.

In November 2008, the Advance Care Planning: Goals of Care Designation (Adult) policy was implemented only within the Calgary area of AHS.

Concurrently, advance care planning work has developed at a national level including the following:
- A national Symposium on advance care planning Symposium was co-sponsored by Fraser Health and the Calgary Health Region in May 2007.
- Health Canada has sponsored advance care planning work through several important research documents including: the “Glossary Project”; “Cross-Cultural Considerations In promoting Advance Care Planning In Canada”; and “Advance Care Planning: An Implementation Guide for health authorities in Canada”.
- Educating Future Physicians in Palliative and End-of-Life Care (EFPPEC) has developed “Facilitating Advance Care Planning: An Interprofessional Educational Program."
- The Canadian Hospice and Palliative Care Association is developing project work related to advance care planning.
Health sector support:
A number of organizations are formally engaged in advance care planning. The work being done at Gundersen Lutheran Medical Foundation in La Crosse, Wisconsin, Fraser Health in British Columbia, and Austin Health in Melbourne, Australia have helped inform the Calgary area initiative.

For the past three years ‘National Hospice Palliative Care Week’ has focused on advance care planning. Professional health care journals have included articles highlighting the need for and importance of advance care planning in providing high quality health care.
Back to Questions
Is a lawyer required to complete a "My Voice" workbook and the attached Personal Directive (PD)?

Alberta law does not require that a lawyer be involved in the completion of a PD or an advance care planning document such as the “My Voice” workbook. The workbook has been designed as a “user friendly” tool to support kitchen table conversations regarding advance care planning. The “My Voice” workbook helps individuals think about, record and communicate their health care preferences to their loved ones and their healthcare providers.

By completing the workbook, an individual’s stated care preferences will be considered. However completing the workbook without completing the Personal Directive does not constitute a legal document. The workbook includes a PD form. A PD must meet the legal requirements, as set out in legislation, to be valid.

For information about Personal Directives Click Here.
Back to Questions
What is the duty of an Alberta Health Services - Calgary and area staff member to comply with a Personal Directive (PD)?
The Regional Personal Directives policy #1407 (internal link) (pending revision) states that “Alberta Health Services staff shall comply with the wishes of patients/clients regarding their care and treatment as specified in a PD, or at the request of an authorized Agent, unless the provision of such services is deemed to be unwarranted or illegal.”

The new “Advance Care Planning: Goals of Care Designation (Adult)” policy indicates the following:

Personal Directive or Patient Request

4.1 Where a Patient’s Personal Directive is known to exist, staff shall make reasonable effort to obtain a copy for placement on the health record (see also the internal link to Personal Directives policy #1407 - pending revision).

4.2 During care provision within the health care sectors defined in this policy, the Most Responsible Health Professional (or designate) shall be notified of the following when clinically relevant:

• when a Patient makes a request limiting Life Support Interventions; or

• a Personal Directive contains clear and relevant instructions requesting limits to Life Support Interventions.

4.3 In the circumstance that a known Personal Directive or Patient request includes a limit on care and treatment, it is the Most Responsible Health Professional’s (or designate’s) responsibility to promptly translate such preferences into a relevant Goals of Care Designation Order, after discussing these limitations with the Patient, where possible. If a Goals of Care Designation Order is not available, the requests to limit care and treatment as outlined in a Personal Directive, or which has been expressed by the Patient, shall be followed, notwithstanding the provisions included in 4.4 below.

4.4 Where the provisions of a Personal Directive or a Patient gives clear and relevant instructions requesting interventions that Certainly will not Benefit, those interventions are not provided (See also Decision Support and Dispute Resolution Resources, Section 8).
Back to Questions
What is the correct course of action if a patient's verbal wishes contradict what they had written earlier in their "My Voice" workbook of Personal Directive (PD)?

This question points out the importance of reviewing the individual’s documentation to clarify any problems with consistency. A patient/client who is competent to make decisions regarding their care may change their mind at any time. It the patient is competent, they should always be included in decision making – if they are competent then the PD should not be enacted.

If the individual still has capacity, and the PD has not been activated, it would be best to identify the inconsistency to the individual. They would then have an opportunity to update their PD and/or their “My Voice” workbook, to ensure they are consistent.

If the individual does not have capacity, and the PD has been activated, the PD stands as the document for guidance. In this situation, if the PD provides specific instructions regarding medical interventions, these directions must be followed. If there are no specific instructions regarding medical interventions, the agent would be responsible for making decisions based on what they believe the individual would have wanted. In this case, they would rely on the most recent conversations they had with the individual.
Back to Questions
Is it permitted for an Alberta Health Services staff member to witness the signing of a Personal Directive (PD)?

According to the AHS Legal Services, staff members may sign as a witness to the signature of the person making the PD. Internal Link to Legal Services.
Back to Questions
Is it permitted for an Alberta Health Services - Calgary and area staff member to be named as an agent for a patient or client?

An agent is defined as an individual authorized to act on the maker’s behalf and make non-financial personal decisions for them when are unable to do so.

AHS Legal Services states that staff should ensure that they are not named as an agent as this is in conflict with the role of providing health care services. This does not apply if the staff member is an agent for their own family member. Internal Link to Legal Services.
Back to Questions
Does the Advance Care Planning: Goals of Care Designation (Adult) policy require the completion of the "My Voice" workbook? My patient has a Personal Directive (PD), an Enduring Power of Attorney and a will that were drawn up by her lawyer. She and her family feel that everything has been attended to and are reluctant to consider any additional documentation.

Your patient and her family can be commended for the important planning they have already done. It is always helpful to review an existing PD to see if it is still relevant and reflects your patient’s wishes in light of her current situation.

The “My Voice” workbook is not mandatory; however, it does provide additional information that may enhance the information in the PD.
Back to Questions
Can the "My Voice" workbook be completed if an existing Personal Directive (PD) has been activated?

When an existing PD has been activated, it is the legal document that must be followed. No one can make a PD for another person. However, they may still wish to use the “My Voice” workbook as a tool to support them in making decisions regarding the individual’s care. The questions in the workbook can help the agent recall events experienced, or statements that the individual made in the past, that might help to clarify their values and wishes regarding health care choices.

If a PD has not been activated, the individual may wish to complete a “My Voice” workbook as well as a new PD.
Back to Questions
How important is it for my patient to complete the "My Voice" workbook and a Personal Directive (PD) if they have already talked with their families and everyone seems to be in agreement?

Will be updated as per new Alberta Laws. Please call us at 403-943-0249 if you have any questions.
Back to Questions
How will the "My Voice" workbook and the Goals of Care Designations inform the care of an individual who must access health care outside the boundaries of Alberta Health Services - Calgary and area, in Alberta or another province?

This policy is an AHS – Calgary and area policy and may differ from other policies in other jurisdictions.

In the event that an individual with a completed Personal Directive (PD) requires care outside of the Calgary area, and was not able to make reasonable care decisions or make their wishes known, the information contained in a “My Voice” workbook and a PD (if outside Alberta) would provide useful guidance to that health care team.

By completing and carrying a “My Voice” wallet card individuals have an opportunity to inform others that they have prepared documents to communicate their wishes to a health care team in an emergency situation. The card will alert them to the existence of PD documents and will also provide the agent’s contact information.
Back to Questions
The person I am caring for already has an Enduring Power of Attorney (EPOA) document. When they ask about the need to complete a "My Voice" workbook and a Personal Directive (PD), what should I tell them?

They need to know that the documents have different purposes. Both the EPOA and the PD allow an individual to make plans for a future loss of capacity which may be temporary or permanent. However, the person named in each of these documents has different responsibilities.

An EPOA allows an individual to name someone to make decisions and manage property and financial affairs. That individual is not permitted to make health care or other medical decisions.

A PD allows an agent to make personal decisions on behalf of an individual, should they become unable to do so for themselves. A personal matter is defined in the Personal Directives Act as being anything of a non-financial nature including: health care; accommodation; with whom the person may live and associate; participation in social, educational and employment activities; non-financial legal matters such as providing consent for the release of medical information and any other personal matter.

For information about Personal Directives Click Here.

For information about Enduring Powers of Attorney Click Here.
Back to Questions

Advance Care Planning Home Current Highlights Advance Care Planning: Goals of Care Designation Policy Background Advance Care Planning Tools Goals of Care & Goals of Care Designations Forms & Processes Education Resources FAQ's Related Publications, Reports & Research Pediatrics Links Contact Us Printer friendly copy of FAQs These are in PDF format. GCDs & Green Sleeve FAQs ACP & Personal Directive FAQs	Advance Care Planning Frequently Asked Questions ACP & Personal Directives Click on any of the questions below to see the answer. Is this advance care planning initiative an Alberta Health Services - Calgary and area program only or is advance care planning being implemented elsewhere? Is a lawyer required to complete a "My Voice" workbook and the attached Personal Directive? What is the duty of an Alberta Health Services - Calgary and area staff member to comply with a personal directive? What is the correct course of action if a patient's verbal wishes contradict what they had written earlier in their "My Voice" workbook of personal directive (PD)? Is it permitted for an Alberta Health Services staff member to witness the signing of a Personal Directive? Is it permitted for an Alberta Health Services - Calgary and area staff member to be named as an agent for a patient or client? Does the Advance Care Planning: Goals of Care Designation (Adult) policy require the completion of the "My Voice" workbook? My patient has a Personal Directive (PD), an Enduring Power of Attorney and a will that were drawn up by her lawyer. She and her family feel that everything has been attended to and are reluctant to consider any additional documentation. Can the "My Voice" workbook be completed if an existing PD has been activated? How important is it for my patient to complete the "My Voice" workbook and a personal directive (PD) if they have already talked with their families and everyone seems to be in agreement? How will the "My Voice" workbook and the Goals of Care Designations inform the care of an individual who must access health care outside the Alberta Health Region - Calgary and area boundaries, in Alberta or another province? The person I am caring for already has an Enduring Power of Attorney (EPOA) document. When they ask about the need to complete a "My Voice" workbook and a Personal Directive (PD), what should I tell them? ANSWERS Is this advance care planning initiative an Alberta Health Services - Calgary and area program only or is advance care planning being implemented elsewhere? The AHS – Calgary area launched work related to advance care planning in the spring of 2005. The initial work focused on developing advance care planning resources using five pilot groups within the Region. In January, 2006, a charter was approved to develop a policy that would provide a regional framework for determining goals of care using the advance care planning processes and resources to support decision-making. In November 2008, the Advance Care Planning: Goals of Care Designation (Adult) policy was implemented only within the Calgary area of AHS. Concurrently, advance care planning work has developed at a national level including the following: A national Symposium on advance care planning Symposium was co-sponsored by Fraser Health and the Calgary Health Region in May 2007. Health Canada has sponsored advance care planning work through several important research documents including: the “Glossary Project”; “Cross-Cultural Considerations In promoting Advance Care Planning In Canada”; and “Advance Care Planning: An Implementation Guide for health authorities in Canada”. Educating Future Physicians in Palliative and End-of-Life Care (EFPPEC) has developed “Facilitating Advance Care Planning: An Interprofessional Educational Program." The Canadian Hospice and Palliative Care Association is developing project work related to advance care planning. Health sector support: A number of organizations are formally engaged in advance care planning. The work being done at Gundersen Lutheran Medical Foundation in La Crosse, Wisconsin, Fraser Health in British Columbia, and Austin Health in Melbourne, Australia have helped inform the Calgary area initiative. For the past three years ‘National Hospice Palliative Care Week’ has focused on advance care planning. Professional health care journals have included articles highlighting the need for and importance of advance care planning in providing high quality health care. Back to Questions Is a lawyer required to complete a "My Voice" workbook and the attached Personal Directive (PD)? Alberta law does not require that a lawyer be involved in the completion of a PD or an advance care planning document such as the “My Voice” workbook. The workbook has been designed as a “user friendly” tool to support kitchen table conversations regarding advance care planning. The “My Voice” workbook helps individuals think about, record and communicate their health care preferences to their loved ones and their healthcare providers. By completing the workbook, an individual’s stated care preferences will be considered. However completing the workbook without completing the Personal Directive does not constitute a legal document. The workbook includes a PD form. A PD must meet the legal requirements, as set out in legislation, to be valid. For information about Personal Directives Click Here. Back to Questions What is the duty of an Alberta Health Services - Calgary and area staff member to comply with a Personal Directive (PD)? The Regional Personal Directives policy #1407 (internal link) (pending revision) states that “Alberta Health Services staff shall comply with the wishes of patients/clients regarding their care and treatment as specified in a PD, or at the request of an authorized Agent, unless the provision of such services is deemed to be unwarranted or illegal.” The new “Advance Care Planning: Goals of Care Designation (Adult)” policy indicates the following: Personal Directive or Patient Request 4.1 Where a Patient’s Personal Directive is known to exist, staff shall make reasonable effort to obtain a copy for placement on the health record (see also the internal link to Personal Directives policy #1407 - pending revision). 4.2 During care provision within the health care sectors defined in this policy, the Most Responsible Health Professional (or designate) shall be notified of the following when clinically relevant: • when a Patient makes a request limiting Life Support Interventions; or • a Personal Directive contains clear and relevant instructions requesting limits to Life Support Interventions. 4.3 In the circumstance that a known Personal Directive or Patient request includes a limit on care and treatment, it is the Most Responsible Health Professional’s (or designate’s) responsibility to promptly translate such preferences into a relevant Goals of Care Designation Order, after discussing these limitations with the Patient, where possible. If a Goals of Care Designation Order is not available, the requests to limit care and treatment as outlined in a Personal Directive, or which has been expressed by the Patient, shall be followed, notwithstanding the provisions included in 4.4 below. 4.4 Where the provisions of a Personal Directive or a Patient gives clear and relevant instructions requesting interventions that Certainly will not Benefit, those interventions are not provided (See also Decision Support and Dispute Resolution Resources, Section 8). Back to Questions What is the correct course of action if a patient's verbal wishes contradict what they had written earlier in their "My Voice" workbook of Personal Directive (PD)? This question points out the importance of reviewing the individual’s documentation to clarify any problems with consistency. A patient/client who is competent to make decisions regarding their care may change their mind at any time. It the patient is competent, they should always be included in decision making – if they are competent then the PD should not be enacted. If the individual still has capacity, and the PD has not been activated, it would be best to identify the inconsistency to the individual. They would then have an opportunity to update their PD and/or their “My Voice” workbook, to ensure they are consistent. If the individual does not have capacity, and the PD has been activated, the PD stands as the document for guidance. In this situation, if the PD provides specific instructions regarding medical interventions, these directions must be followed. If there are no specific instructions regarding medical interventions, the agent would be responsible for making decisions based on what they believe the individual would have wanted. In this case, they would rely on the most recent conversations they had with the individual. Back to Questions Is it permitted for an Alberta Health Services staff member to witness the signing of a Personal Directive (PD)? According to the AHS Legal Services, staff members may sign as a witness to the signature of the person making the PD. Internal Link to Legal Services. Back to Questions Is it permitted for an Alberta Health Services - Calgary and area staff member to be named as an agent for a patient or client? An agent is defined as an individual authorized to act on the maker’s behalf and make non-financial personal decisions for them when are unable to do so. AHS Legal Services states that staff should ensure that they are not named as an agent as this is in conflict with the role of providing health care services. This does not apply if the staff member is an agent for their own family member. Internal Link to Legal Services. Back to Questions Does the Advance Care Planning: Goals of Care Designation (Adult) policy require the completion of the "My Voice" workbook? My patient has a Personal Directive (PD), an Enduring Power of Attorney and a will that were drawn up by her lawyer. She and her family feel that everything has been attended to and are reluctant to consider any additional documentation. Your patient and her family can be commended for the important planning they have already done. It is always helpful to review an existing PD to see if it is still relevant and reflects your patient’s wishes in light of her current situation. The “My Voice” workbook is not mandatory; however, it does provide additional information that may enhance the information in the PD. Back to Questions Can the "My Voice" workbook be completed if an existing Personal Directive (PD) has been activated? When an existing PD has been activated, it is the legal document that must be followed. No one can make a PD for another person. However, they may still wish to use the “My Voice” workbook as a tool to support them in making decisions regarding the individual’s care. The questions in the workbook can help the agent recall events experienced, or statements that the individual made in the past, that might help to clarify their values and wishes regarding health care choices. If a PD has not been activated, the individual may wish to complete a “My Voice” workbook as well as a new PD. Back to Questions How important is it for my patient to complete the "My Voice" workbook and a Personal Directive (PD) if they have already talked with their families and everyone seems to be in agreement? Will be updated as per new Alberta Laws. Please call us at 403-943-0249 if you have any questions. Back to Questions How will the "My Voice" workbook and the Goals of Care Designations inform the care of an individual who must access health care outside the boundaries of Alberta Health Services - Calgary and area, in Alberta or another province? This policy is an AHS – Calgary and area policy and may differ from other policies in other jurisdictions. In the event that an individual with a completed Personal Directive (PD) requires care outside of the Calgary area, and was not able to make reasonable care decisions or make their wishes known, the information contained in a “My Voice” workbook and a PD (if outside Alberta) would provide useful guidance to that health care team. By completing and carrying a “My Voice” wallet card individuals have an opportunity to inform others that they have prepared documents to communicate their wishes to a health care team in an emergency situation. The card will alert them to the existence of PD documents and will also provide the agent’s contact information. Back to Questions The person I am caring for already has an Enduring Power of Attorney (EPOA) document. When they ask about the need to complete a "My Voice" workbook and a Personal Directive (PD), what should I tell them? They need to know that the documents have different purposes. Both the EPOA and the PD allow an individual to make plans for a future loss of capacity which may be temporary or permanent. However, the person named in each of these documents has different responsibilities. An EPOA allows an individual to name someone to make decisions and manage property and financial affairs. That individual is not permitted to make health care or other medical decisions. A PD allows an agent to make personal decisions on behalf of an individual, should they become unable to do so for themselves. A personal matter is defined in the Personal Directives Act as being anything of a non-financial nature including: health care; accommodation; with whom the person may live and associate; participation in social, educational and employment activities; non-financial legal matters such as providing consent for the release of medical information and any other personal matter. For information about Personal Directives Click Here. For information about Enduring Powers of Attorney Click Here. Back to Questions
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Advance Care Planning

Frequently Asked Questions

ACP & Personal Directives

Click on any of the questions below to see the answer.