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

9. Ensure advanced directives are internally consistent with respect to treatment goals

While estate lawyers are not physicians, and may not feel that they are in the best position to advise their clients on what to include in advance directives, they can and do play a crucial role in advance care planning: if nothing else, they may be the ones who initiate the dialogue and ask clients to consider some of the most important decisions they will make in their lives.

If the client is uncertain, a lawyer can encourage him or her to ask his or her physician and healthcare teams what needs to be considered with respect to the treatments described here or any other treatments he or she is anticipated to need in the unique context of his or her state of health.

If the client is expressing any advance directives that seem on the surface to be internally inconsistent with respect to his or her declared values and treatment goals, lawyers should gently question such difference and may wish to suggest the client engage in further discussions with his or her healthcare team before proceeding with the creation of legal documents.

Go to Step 10

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.

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