Are Canadians Providing Advance Directives about Health Care and Research Participation in the Event of Decisional Incapacity?

Authors

Gina Bravo
Marie-France Dubois
Carole Cohen
Sheila Wildeman, Dalhousie University Schulich School of LawFollow
Janice Graham
Karen Painter
Suzanne Bellemare

Document Type

Article

Publication Date

2011

Keywords

Health Law and Policy; Decisional Incapacity; Advance Directives; Advance planning for health care and research participation; Substitute decision making

Abstract

Objective: Advance planning for health care and research participation has been promoted as a mechanism to retain some control over one’s life, and ease substitute decision making, in the event of decisional incapacity. Limited data are available on Canadians’ current advance planning activities. We conducted a postal survey to estimate the frequency with which Canadians communicate their preferences about health care and research should they become incapacitated. Method: We surveyed 5 populations (older adults, informal caregivers, physicians, researchers in aging, and research ethics board members) from Nova Scotia, Ontario, Alberta, and British Columbia. We asked respondents whether they had expressed their preferences regarding a substitute decision maker, health care, and research participation in the event of incapacity. Results: Two out of 3 respondents (62.0%; 95% CI 59.1% to 64.8%) had been advised to communicate their health care preferences in advance. Oral expression of wishes was reported by 69.1% of respondents (95% CI 66.8% to 71.3%), and written expression by 46.7% (95% CI 44.3% to 49.2%). Among respondents who had expressed wishes in advance (orally or in writing), 91.2% had chosen a substitute decision maker, 80.9% had voiced health care preferences, and 19.5% had voiced preferences regarding research participation. Having been advised to communicate wishes was a strong predictor of the likelihood of having done so. Conclusions: Advance planning has increased over the last 2 decades in Canada. Nonetheless, further efforts are needed to encourage Canadians to voice their health care and research preferences in the event of incapacity. Physicians are well situated to promote advance planning to Canadians.

Comments

From the Selected Works of Sheila Wildeman.

Recommended Citation

Gina Bravo et al, “Are Canadians Providing Advance Directives about Health Care and Research Participation in the Event of Decisional Incapacity?” (2011) 56:4 CJP 209.

Publication Abbreviation

CJP