Estate Planning: Ten Practical Steps to Improve Written Advance Directives in Powers of Attorney for Healthcare


Powers of attorney for personal care and healthcare allow all of us to express some of the values, beliefs and quality of life issues that define who we are as persons. While brilliant in conception, they have struggled in their application to systematically and accurately reflect the values and wishes they seek to state, resulting in substitute consent to unwanted treatments or, perhaps worse, refusal of treatment trials that the client would in fact wish to undergo. Furthermore, such documents may be inaccessible or silent at the time they are most needed. The ten practical steps outlined in this article aim to promote greater clarity in expressing values and wishes, prevent and diminish confusion for designated SDMs and healthcare teams, and improve the quality of care provided and received at the end of life.

The author wishes to encourage and engage in discussion regarding the directives she proposes here. Please take a moment to express your thoughts and critical commentary in the comments section below.

About the Author


LAURA HAWRYLUCK received her MD in 1992 from the University of Western Ontario where she also served her Internal Medicine residency. She completed a Fellowship in Critical Care at the University of Manitoba in 1997 and received her MSc in Bioethics in 1999 from the Joint Centre for Bioethics and the Institute of Medical Science at the University of Toronto. From 1999-2001 she was Assistant Professor of Critical Care/Internal Medicine, Queen’s University, Kingston, Ontario. In March 2000 she was appointed Physician Leader of the national Ian Anderson Continuing Education Program in End-of-Life Care at the University of Toronto and is currently Associate Professor of Critical Care Medicine at the University of Toronto. In 2002, she was awarded the Queen’s Golden Jubilee Medal for contributions to Canada in recognition of her work in creating the Anderson Program and improving end of life care for Canadians. Dr. Hawryluck is co-author and editor of “Law of Acute Care in Canada” to be published shortly by Carswell, a division of Thomson Reuters.

Dr. Hawryluck is deeply involved in international humanitarian projects. She has worked with critical care and burn units in Indore India and Cote d’Ivoire on a variety of quality improvement and educational initiatives. She was co-creator and co-Director for RCCI of the first Doctorate in Medicine Program in Critical Care in the entire country of Nepal. She worked with the Nepal Medical Council as an international consultant to enact a Code of Ethics and Professionalism for all physicians in Nepal.

One thought on “Estate Planning: Ten Practical Steps to Improve Written Advance Directives in Powers of Attorney for Healthcare”

  1. I didn’t comment on each section but overall I find this valuable information to help people make plans for the end of life. The wallet sized card is an excellent idea and could also be provided to all of the POAs/SDMs to assist with problem solving during exceedingly difficult and emotional times for the family. Unfortunately, this work is often undone, especially for young people, and damaged relationships result.

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