Kirsten Larsen
Northern News Services

NNSL (Feb 05/99) - Northerners who are admitted to Alberta hospitals are being asked questions which require some thought about managing the future of their health.

The government of Alberta implemented The Personal Directives Act in 1997 legalizing the use of documents written by people which outline what medical treatment they would want in the event that they are indisposed, or permanently incapable of making decisions relating to their medical care.

Northerners medevaced to hospitals in Edmonton have been given the same rights while treated in Alberta, although there is no similar legislation governing the Northwest Territories.

"When our patients go to Alberta for treatment they will hear about it and be asked on admission (if they have a personal directive)," said Carol Anderson, director of patient care at Stanton Regional Hospital.

"We want them to know that they will be asked that question and what it means. To let them know they have that opportunity, if they want, to develop a personal directive and that they can do so prior and know that legislation (in Alberta) is in place."

Similar to Alberta, legislation legalizing the use of personal directives or "living wills", is implemented in British Columbia, Manitoba, Ontario, Quebec and Nova Scotia. Personal directives are only honoured in those provinces. So, even if a person is covered under Alberta Medicare, and receives treatment in a province or territory that doesn't have the legislation, the medical staff in attendance are not obligated to honour the directive.

The GNWT does not have legislation in place to legally endorse the use of personal directives, although the matter has been discussed. The NWT Seniors Society made a request over a year ago that the GWNT consider legislating a personal directives plan and the GNWT has expressed that the matter will likely be addressed after the division of the NWT.

Although a personal directive is not viewed as an official legal document in the NWT it can still provide helpful insight for relatives and people who may have to make decisions when a person becomes incapable. The person who writes the document can appoint someone to act as the consultant with medical staff and use the documented wishes as guide.

The person writing the document can provide information about treatments which would or would not be acceptable to them given a certain situation.

"One thing (a personal directive) does, is allow you to describe situations and what you would want in those situations," said Anderson. "If you can describe situations for reversible or irreversible (medical conditions) then medical staff would be looking at the document for direction. It gives decision makers support for the decisions they have to make."

In cases when a person's health is failing, the documentation is ideal to outline and discuss requests with relatives and loved ones prior to an incident. In the event of an immediate and unexpected life-threatening incident, the document can be supportive for those that have to make decisions in a stressful situation.

A person's thoughts about treatments such as life support or CPR can be expressed in regards to what they consider a reversible, irreversible, tolerable or intolerable medical condition.

Although a person's request must be within the bounds of the law, it can help jump over the moral, and ethical questions which could complicate the situation when a decision must be made.

"There are certainly many ethical questions surrounding withdrawal or withholding those things but it is not illegal," said Anderson. "It is illegal to ask someone to give you an injection of some medication to kill you."

The wording and format for a personal directive can be complex and confusing, but with the help of published material about how to develop a living will, the process can be simplified.

A Canadian publication entitled Let Me Decide developed by Dr. William Molloy and Virginia Mepham includes a working form along with suggestions for wording and definitions of medical terms and treatment. The publication is available in the Yellowknife Public Library.

Brochures explaining Alberta's Personal Directives Act and a reference copy of the Act can be obtained through the administrative office at Stanton Regional Hospital.