The recent case of Florida’s Terri Schiavo drives home how families can be divided, and even torn apart, when assisting loved ones who have lost the ability to make their own medical decisions. It also shows how people who know and love someone can reach opposite conclusions about their wishes for care.

Fortunately, since 2000, the Representation Agreement Act has permitted adult British Columbians to make decisions regarding their health and personal care. It is similar to an Enduring Power of Attorney, in that it may also cover financial and legal matters, but it has a much broader scope.

The person making the Representation Agreement can express their wishes respecting desired medical care within the document. However, the primary purpose of a Representation Agreement is to appoint a representative and give him/her the power to determine the wishes of the adult at the time that a decision needs to be made.

The Representation Agreement Act sets out procedures for the creation, signing, and challenging of a Representation Agreement. There are actually two types of agreements described in the Act. A “standard” (or “Section 7”) Representation Agreement covers routine financial, personal care, and medical decisions. This type does not need to be prepared by a lawyer. However, most people prefer the “Enhanced” (or “Section 9”) Representation Agreement, which can cover all matters, including “end of life” decisions. A lawyer must be consulted when making an Enhanced Representation Agreement.

Some people also make Enhanced Powers of Attorney, which give decision-making powers for financial and legal matters, even after the loss of mental capacity. However, as powers of attorney do not permit the attorney to make decisions related to health care, they would be of minimal value in a Terri Schiavo-type situation.

People sometimes confuse Representation Agreements with “Living Wills”. A Living Will is a document that permits an adult to express his/her wishes regarding medical treatment in the event of subsequent mental incapacity. While sounding similar to a Representation Agreement, a Living Will has several problems. First, it only describes the types of treatment that are permissible. Given advances in medical care, and the time lapse that often occurs between making the Living Will and its use, it often no longer reflects the person’s wishes. Second, a Living Will does not permit the appointment of a decision-maker. As a result, if a “judgment call” must be made, no authority is given through a Living Will. Third, except in very narrow circumstances, Living Wills are not legal in British Columbia. Hence, doctors do not have to follow the directions outlined in a Living Will.

For those in British Columbia wishing to avoid placing their families in the same difficult situation faced by the supporters of Terri Schiavo, a Representation Agreement provides a reasonable, legal solution.