Originally published: October 20, 2015 | Last updated: December 11, 2024
The main obstacle which prevents Canadian citizens from creating advance care plans stems from the different words which provinces use to describe these healthcare directives. Different geographical areas establish various terms to describe the same concept which appears under three to four different names. Healthcare professionals together with lawyers and government agencies use these terms without distinction although their legal meanings differ from each other. This guide solves the problem by providing clear definitions for every term and showing their connections to each other.
One of the biggest barriers to advance care planning in Canada is the inconsistent terminology used across provinces. The same concept may have three or four different names depending on where you live. Healthcare professionals, lawyers, and government agencies sometimes use these terms interchangeably, even though they can have distinct legal meanings. This guide cuts through the confusion by defining each term precisely and explaining how they relate to each other.
What Is Advance Care Planning?
Advance care planning (ACP) is the broad process of thinking about, discussing, and documenting your wishes for future healthcare in case you become unable to communicate. It is not a single document, it is an ongoing conversation between you, your family, and your healthcare providers. The outputs of advance care planning typically include a written directive (Living Will or advance directive) and the appointment of a substitute decision-maker (through a Power of Attorney or representation agreement). ACP is recommended for every adult, regardless of age or health status, because incapacity can result from accidents, strokes, or sudden illness at any time.
The entire process of advance care planning (ACP) requires you to think about your medical preferences for times when you lose your ability to speak while making sure you document these choices. The document exists as a continuous dialogue which involves you along with your family members and your medical team. The final products of advance care planning consist of two main documents which include a written directive called a Living Will or advance directive and a substitute decision-maker appointment through Power of Attorney or representation agreement. ACP serves as a vital healthcare measure which doctors need to provide all adults because any person can lose their ability to make decisions through unexpected medical events.
A Living Will is a written document that records your specific wishes about medical treatment in situations where you cannot speak for yourself. It typically addresses decisions about life-sustaining treatment (ventilators, CPR), artificial nutrition and hydration (feeding tubes, IV fluids), pain management preferences, organ donation, and end-of-life care. The term “Living Will” is widely understood by the public but is not an official legal term in most Canadian provinces. Instead, provinces use their own terminology; see the table below. For a broader overview, see where the Living Will fits in your estate plan.
What Is a Living Will?
An advance directive (also called a “personal directive” in Alberta and Nova Scotia, or a “health care directive” in Manitoba and Saskatchewan) is the legally recognized version of what most people call a Living Will. It is a formal document, governed by provincial legislation, that records your healthcare wishes. In some provinces, an advance directive can also name a substitute decision-maker, while in others, that function is handled by a separate document. The key distinction from a Living Will is that an advance directive is the specific legal instrument recognized by your province, while “Living Will” is the commonly understood umbrella term.
A Living Will exists as a written document which allows you to state your medical treatment preferences for situations when you lose the ability to speak. The document contains information about medical choices which include ventilator use and CPR and artificial nutrition and hydration through feeding tubes and IV fluids and pain management options and organ donation decisions and complete end-of-life care plans. The Canadian public knows about Living Wills but this term does not exist as an official legal document in most Canadian provinces. The provinces use their own terms which you can find in the table below. For a broader overview, see where the Living Will fits in your estate plan.
A substitute decision-maker (SDM) is a person authorized to make healthcare decisions on your behalf when you cannot. Different provinces use different terms for this role: healthcare proxy, healthcare agent, representative, or attorney for personal care. An SDM is typically appointed through a Power of Attorney for Personal Care or a Representation Agreement. In some provinces, if you have not formally appointed an SDM, legislation designates a “temporary substitute decision-maker” (TSDM), usually your spouse, then adult child, then parent, who can make decisions based on a statutory hierarchy. However, relying on the TSDM framework is risky because the hierarchy may not reflect your actual preferences for who should decide.
What Is an Advance Directive?
A representation agreement is the term used in British Columbia for a document that appoints someone to make healthcare and personal care decisions on your behalf. BC offers two types: a Section 7 agreement (which covers routine health and personal care decisions) and a Section 9 agreement (which covers more significant decisions including refusing life-sustaining treatment). This is roughly equivalent to what other provinces call a Power of Attorney for Personal Care, but with BC-specific requirements and terminology.
Most people understand an advance directive as a Living Will but Alberta and Nova Scotia refer to it as a personal directive and Manitoba and Saskatchewan use the term health care directive for the same document. The document exists as a formal record which provincial laws regulate to show your medical treatment preferences. A person can use their advance directive to name someone who will make decisions for them but different provinces require separate documents to carry out this function. Your province will recognize advance directives as official legal documents but most people understand Living Will as the general term which includes these documents.
A Power of Attorney for Personal Care (called by various names across provinces) is a legal document that appoints a specific person to make healthcare and personal care decisions on your behalf if you become incapacitated. This is distinct from a Power of Attorney for Property/Finances, which deals with financial decisions. The healthcare Power of Attorney names who decides; the Living Will or advance directive tells them what you want. Together, they ensure your healthcare wishes are known and someone is legally authorized to carry them out.
What Is a Substitute Decision-Maker?
| The substitute decision-maker (SDM) system allows people to choose someone who will make healthcare decisions for them when they lose their ability to make decisions. The role receives different names across provinces which include healthcare proxy and healthcare agent and representative and attorney for personal care. An SDM becomes official through the process of Power of Attorney for Personal Care or Representation Agreement. The law creates a process in certain provinces which allows your spouse to serve as a temporary substitute decision-maker (TSDM) if you have not selected an SDM but follow the order of spouse then adult child then parent. The TSDM system fails to protect you because its ranking system probably does not match your actual choices for decision-making authority. | What Is a Representation Agreement? | A representation agreement is the term used in British Columbia for a document that appoints someone to make healthcare and personal care decisions on your behalf. BC provides two agreement types which Section 7 addresses standard health and personal care choices and Section 9 covers essential medical decisions which include life support treatment refusal. The document serves the same purpose as other provinces refer to as Power of Attorney for Personal Care but BC has its own distinct rules and official terms. |
|---|---|---|
| What Is a Power of Attorney for Personal Care? | – | A Power of Attorney for Personal Care exists as a legal document which different provinces call by different names while it allows you to select a person who will handle your healthcare and personal care decisions when you lose your ability to decide. The document serves a different purpose than a Power of Attorney for Property/Finances because it focuses on medical treatment choices. The healthcare Power of Attorney names who decides; the Living Will or advance directive tells them what you want. The documents work together to show your healthcare choices and they establish proper authorization for medical treatment administration. |
| Provincial Terminology at a Glance | Province | Instruction Document |
| Decision-Maker Document | Ontario | Power of Attorney for Personal Care |
| British Columbia | Advance Directive | Representation Agreement |
| Alberta | Personal Directive | Personal Directive (combined) |
| Saskatchewan | Health Care Directive | Health Care Directive (combined) |
| Manitoba | Health Care Directive | Health Care Directive (combined) |
| Quebec | – | Advance Medical Directives |
Mandate in Case of Incapacity
A complete Canadian estate plan requires three core documents working together:
- Last Will and Testament: Handles asset distribution after death. Create yours here.
- Power of Attorney (financial and healthcare): Names decision-makers for finances and medical care during incapacity.
- Living Will / Advance Directive: Records your specific healthcare treatment preferences.
Without all three, there are gaps in your protection. A Will alone does not help if you become incapacitated. A Power of Attorney without a Living Will leaves your substitute decision-maker guessing about your wishes. LegalWills.ca helps you create all three documents, customized for your province, in a single session. For foundational concepts, review our estate planning glossary.
Tim Hewson is one of the founders of LegalWills.ca.
He has over 20 years of experience helping people to write their Will and other estate planning documents. He has been interviewed by many of the major news media outlets including CTV, Global News, The Toronto Star, and other leading Canadian publications. He has also contributed to a number of financial planning books.
Throughout his career, Tim has written extensively on the subject of Will writing and estate planning.
