Advance directives are legal documents that describe what you want for your medical care, finances and estate. They allow you to clearly outline your decisions about end-of-life care and who will act on your behalf when necessary. Advance directives take effect only when you die or if you become unable to make decisions.
Thinking about wills and funerals probably isn’t how you and your family want to spend your time right now. But if you can discuss practical matters openly and early, before a health crisis happens, it can make everyone feel a bit more at ease. You can be sure that your wishes for end-of-life care are understood. And it can relieve some of the stress and uncertainty for caregivers and family.
Laws about advance directives differ from province to province. It’s best to talk to a lawyer or your healthcare team for more detailed information. Copies of any advance directive you make can be given to a lawyer, your healthcare team (to be put in your medical file) or next of kin.
A living will is a set of instructions about a person’s wishes for medical care. If you become unable to communicate or make decisions, a living will tells caregivers and the healthcare team your wishes about medical care issues such as:
- use of breathing machines (ventilators)
- use of cardiopulmonary resuscitation (CPR) if breathing or heartbeat stops
- artificial feeding, such as tube feeding
- instruction for treatments, such as antibiotics, pain or antinausea medicines
- continuing or not continuing with treatment, such as chemotherapy or radiation therapy
- organ, tissue or body donation
People with advanced cancer have the right to refuse treatment. They can use a living will to make sure that everyone knows their wishes.
It’s a good idea to talk about these medical care decisions with the people who matter most to you. Once you’ve made your living will, you can carry a wallet card to say that you have one and where it can be found.
Giving someone power of attorney means that person has the legal authority to act for you if you become unable to do so. A power of attorney should be someone you know well and trust.
Most people chose 2 powers of attorney. A medical power of attorney (or proxy) gives someone the authority to make medical or healthcare decisions for you. A financial power of attorney gives someone the authority to make your financial decisions. You can choose different people to have financial power of attorney and medical power of attorney or you may choose to give one person both responsibilities.
You can choose who will be your power of attorney at any time, but it’s best to choose them while you can still make your own decisions (otherwise, one may be appointed for you). Be sure to discuss your wishes for financial, medical or healthcare decisions with the person who will act as your power of attorney.
A will gives legal instruction about how you want your estate (money, property or other assets) handled when you die. It can also include who will look after your children (under age 18) or who should look after pets. In your will, you can name a family member, friend or professional who will see that the terms of the will are carried out (this person is called the executor or executrix).
You may want to change an existing will or create a new one when you’ve been diagnosed with advanced cancer.
Some people with advanced cancer want to be involved in decisions about a funeral or memorial service. Others may not.
Planning ahead does mean that family or close friends won’t have to make these decisions when they are grieving and have little time to think them through. Knowing that your wishes will be carried out may also bring you peace of mind.
Preplanning can include decisions about:
- whether you wish to be buried or cremated
- if you would like your ashes to be buried, scattered or kept by loved ones
- your wishes for a funeral, memorial service or something else, where it should be held and any special instructions for the service
If you’re ready, talk to a funeral director, spiritual advisor or social worker. Share your decisions and plans with family members and keep a copy of documents related to final arrangements with your other important papers. If you have special wishes related to any religious, spiritual or cultural practices around dying or after death, make sure caregivers and the healthcare team know about them.
If you choose not to make detailed final arrangements, you should still let loved ones know whether you prefer to be buried or cremated.
Some people with cancer may think about becoming an organ, tissue or body donor after their death.
The health of the donor is the most important thing considered for organ and tissue donations. All organs and tissues considered for transplant undergo careful testing to make sure they are healthy and suitable for donation. This is done to protect the health of any person who may receive the organ(s). For more information about organ or tissue donation, contact the organ or transplant program in your province.
- Sometimes people with cancer may be allowed to donate their eyes for corneal transplants.
- People who have been in complete remission for a number of years may be able to donate their organs and tissues.
- People who have cancer that has spread (metastatic) are not able to donate organs or tissue.
People with cancer who are not able to donate their organs may still be able to donate their body to a medical school or research facility, if this is one of their wishes.
Most medical schools or research facilities have a process in place to accept body donations. Cremation of the body takes place after use, and may be returned to your family if they wish. You may want to contact the institution where you would like to donate your body for the requirements of the program, and to make arrangements for transportation to the facility after death.
A decrease in or the disappearance of signs and symptoms of a disease (such as cancer).
Complete remission means the disappearance of all signs or symptoms. Partial remission means a decrease in or disappearance of some, but not all, signs and symptoms. Spontaneous remission is an unexpected improvement that occurs with little or no treatment.
Great progress has been made
Some cancers, such as thyroid and testicular, have survival rates of over 90%. Other cancers, such as pancreatic, brain and esophageal, continue to have very low survival rates.