What is a Representation Agreement?

 A Representation Agreement is a tool that allows your appointed representative to make personal and health care decisions for you. There are 2 types of Representation Agreements, Standard and Enhanced.   Standard Representation Agreements cover routine financial and/or health care decisions, while Enhanced Representation Agreements give broader powers to the representative, including end of life decision making.

A Representation Agreement is the only way to authorize someone called your representative to assist you or to act on your behalf for health care and personal care matters.  It can also cover routine financial affairs and legal matters.

Representation Agreements include your health care needs, you may appoint a Monitor who will ensure that your representative is carrying out your wishes. In some cases the monitor is optional.


What is an Advance Directive?

An Advance Directive is a legal document prepared and signed by a person in advance of a severe illness or injury providing instructions to give or refuse consent to certain health care matters.   The Advance Directive must be made when the adult is capable of understanding the nature and effect of what it covers.  An Advance Directive only applies to health care and can consent to or refusing life support or life prolonging medical interventions. Note that an Advance Directive does not appoint a person to act on your behalf.   The Advance Directive must be specific as possible about the circumstances related to a treatment or intervention.  An instruction such as “I give consent to surgery” or “I refuse consent to surgery” is likely not specific enough. Provided that the written instructions in the Advance Directive are clear they are to be followed by a healthcare practitioner who is aware of the Advance Directive and when no one will be able to make a decision for you.  However, even if your Advance Directive provides clear instructions, a health care provider must not follow your Advance Directive if.

An Advance Directive cannot address all possible health care decisions that may arise for you in the future and a health care provider could reject your instructions for one of a number of reasons.  A Section 9 Representation Agreement can cover more health care matters that an Advance Directive and carries more authority because it gives a person the authority to carry out your wishes, even if a health care provider is unsure your instructions applies.  

Who can make a Representation Agreement?

 An adult (19 years of age or older in BC) who is capable of understanding the nature of authority being given to the Representative, and effect of giving authority may make a section 9 Representation Agreement.

In the event the adult is unable to meet the capacity requirements for creating a Section 9 Representation Agreement, they may be able to create a Section 7 Representation Agreement. To create this, an Adult need not be capable of: making a contract managing his/her own health, personal care, legal affairs, or financial affairs.  The Adult must be capable of:

  1. Communicating their desire to have a representative make, help make, or stop making decisions on their behalf. In addition, the adult must demonstrate whether they are aware that making the representation agreement, or changing or revoking any of the provisions, means that the representative may make, or stop making, decisions or choices that affect the adult;
  2. Demonstrating choices and preferences, and can express feelings of approval or disapproval of others; and
  3. Communicating whether they have a relationship with the representative characterized by trust.

Do I need to appoint a family member to be my Representative?

 No, you can appoint any person you trust to be your representative through your Representation Agreement.

Can I revoke or change my Representation Agreement in the future?

Yes, you may change or revoke your Representation Agreement anytime provided that you meet the same capacity requirements that are required for an adult to have made an agreement.

Can I revoke or change my Representation Agreement in the future?

Yes, you may change or revoke your Representation Agreement anytime provided that you meet the same capacity requirements that are required for an adult to have made an agreement.


Do I need to appoint a Representative or have an Advance Directive?

 No, you do not need to appoint a Representative through a Representation Agreement, nor are you required to have an Advance Directive. You may opt to instead allow your healthcare provider to choose a Temporary Substitute Decision (“TSDM”)  maker in the event a decision needs to be made regarding your healthcare and you are unable to communicate your wishes. However, a TSDM  only has authority to make certain health care decisions. For example, the TSDM can only refuse consent for life support if the majority of the medical team agrees it is medically appropriate. The TDSM is also limited by the “temporary” nature of their authority.  A TSDM is only selected when the health care provider determines the adult is incapable of informed consent to health care and a decision needs to be made.  A TDSM’s authority only lasts for that specific decision. A TSDM also does not have legal authority to make personal care decisions such as living arrangements, diets, grooming, personal safety and support services.   A Temporary Substitute Decision Maker is appointed by your health care provider who must choose the first, in listed order, of the following who is at least 19 years of age or older, have been in contact with you in the past 12 months, currently has no dispute with you, is capable of giving, refusing or revoking substitute consent and is willing to comply with their duties under section 19 of the health care (consent) and care facility (admission) act.:

(a) The adult’s spouse;

(b) The adult’s child;

(c) The adult’s parent;

(d) The adult’s brother or sister;

(d.1) the adult’s grandparent;

(d.2) the adult’s grandchild;

(e) Anyone else related by birth or adoption to the adult;

(f) A close friend of the adult;

(g) A person immediately related to the adult by marriage.