Interested in Creating an Advance Directive? (Living Will)
With the attention focused on the Terri Schiavo case in the media, many people are wondering: What can I do to prevent this from happening in my family?
Terri Schiavo is the severely brain-damaged woman in Florida who is at the heart of the battle over whether a feeding tube that has kept her alive for 15 years should be re-inserted. Terri’s husband, Michael, believes that Terri would never want to go on living in the condition she is in. Terri’s parents and siblings feel that Terri should be kept alive at all costs, and that by not allowing a feeding tube to keep her fed and hydrated, she is being “killed”.
The best way to avoid a similar acrimonious battle is to put your wishes in writing, and then to have a heart-to-heart talk with your loved ones about what you would like to happen and what kind of health care choices you wish to have made should you no longer be able to do so.
In Ontario, the Health Care Consent Act (1996) says that when people are no longer able to make decisions for themselves, a Substitute Decision Maker is authorized to make decisions on their behalf. Most often this person will be a family member, as outlined according to a hierarchy in the Act. Substitute decision makers are required to follow two principles in their decision-making:
1. Prior capable wishes
2. Best Interests

While capable, a person may express wishes in respect to treatment, admission to care facilities, personal assistance services and so on. The Substitute Decision Maker must follow these expressed wishes wherever possible. The manner in which these wishes are expressed can be in any format: by making out a power of attorney for personal care, by completing an advance directive (living will), or in any other written form. They can also be expressed verbally. For example, a person may have told family members that she would never want any tubes put in for feeding if she became unable to make decisions for herself.
Many Advance Directive forms have been developed to assist people to express their wishes for future care. While not intended to be used in the absence of specific medical and legal advice, they can help people determine what their wishes might be and help them to communicate to others. The following are some examples that are readily available:
The CareWish Advance Directive for Personal Care was developed here in London. It contains instructions, a form, a fridge magnet and a card to put in your wallet/purse. It is available for $6.00 from the Hospital Gift Shops or by mail for $8.00 from the Communications & Public Affairs Offices
The University of Toronto Joint Centre for Bioethics Living Will. This was developed by Dr. Peter A Singer, and is a guide to help you think about and express your wishes about future health and personal care decisions. Information about living wills and forms are available for downloading free at http://jointcentreforbioethics.ca/tools/livingwill.shtml