Planning for ‘the last 100 yards’ and beyond
Not knowing where to start is one of the barriers that prevent Canadians from estate planning, yet experts say taking action can bring clarity and improve outcomes. luke chan via getty images
Joyful anticipation – which comes with mapping out life stages like educational and career pathways or family and retirement planning – is not a sentiment commonly associated with end-of-life preparations.
Yet formulating a plan for what Samir Sinha, a geriatrician and clinician scientist with the Sinai Health System and University Health Network and director of Health Policy Research at the National Institute on Ageing, likes to call “the last 100 yards” is just as important.
“The biggest reason why people don’t get around to estate planning – including preparing a will or power of attorney – is that thinking about that stage in life makes them uncomfortable,” he says. “Many people are reluctant or don’t see a reason to plan ahead. Younger people may not think there’s a need for immediate action.”
The resulting gap in preparedness, however, can have significant consequences not only for matters relating to death but for navigating potential health challenges. That’s why Dr. Sinha initiates such conversations early on with his patients.
“When I recently met with a couple for the first time, I told them I need to know their preferences by our next appointment,” he recalls. “When they came back, they thought they had acted on my advice by showing their children their plot in the cemetery.
“I said, ‘I don’t care what happens after you cross the finish line – as your health-care provider, I want to know how we manage the last 100 yards,’” says Dr. Sinha, who is also a professor at the University of Toronto, Toronto Metropolitan University and the Johns Hopkins University Schools of Medicine.
He told the couple to “have a chat and figure out who will make decisions in the event they cannot – and how these decisions should play out.”
“The biggest reason why people don’t get around to estate planning – including preparing documents like a will or power of attorney – is that thinking about that stage in life makes them uncomfortable. Many people are reluctant or don’t see a reason for planning ahead, and younger people may not think there’s a need for immediate action. ”
Clarity on ‘what’s important for living in a meaningful way’
A report by the National Institute on Ageing (NIA) in collaboration with RBC Royal Trust – titled Where There’s a Will, There’s a Way: Exploring Canadian Perspectives on Estate Planning – found that less than half of Canadians have a will, and even fewer have a comprehensive estate plan.
Dr. Sinha, a co-author of the report, emphasizes that making a will gives people “a chance to have a measure of control in case something happens.
“If we don’t have clarity about a person’s wishes, that’s when confusion can ensue,” he says, adding that in a health-care setting in the event of a medical crisis, “this could mean [the care team] might do things you wouldn’t want us to do.”
Given the wide spectrum of potential medical interventions, choices have to be aligned with personal circumstances and preferences, Dr. Sinha explains. “For some people, their belief system [aligns with] the goal to live as many days as humanly possible even in the face of pain and suffering. Others may say, ‘I don’t want to be kept alive at all costs.’ Since everyone is different, people need to be clear about what they’re willing – or not willing – to include in their care plans.”
Advance directives like DNR (do not resuscitate), DNI (do not intubate) or AND (allow natural death) can provide valuable guidance. However, “there is a chance our present self cannot foresee what our future self might want or need,” he says. “That’s where it is helpful to talk through scenarios or give examples that can help your future care-providers and decision-makers understand what interventions would be appropriate in different circumstances.”
Understanding “the things that are important to you for living in a meaningful way” can provide valuable clues, says Dr. Sinha. “You might say, ‘I don’t want to be in pain. I don’t want to be bed-bound. I don’t want to be in a situation where I can’t recognize – and communicate with – others.’ Having these conversations can be very empowering.”
Assigning powers of attorney
In addition to a will, another legal document used in estate planning is a power of attorney (POA), which allows people to assign decision-making privileges – including for financial and personal care-related decisions – in case they become incapacitated, whether for temporary convenience or long-term incapacity.
In the absence of such a document, physicians follow provincial guidelines – such as Ontario’s Substitute Decision Makers Act – for care-related questions, says Dr. Sinha. “Under this act, if you become unconscious, I’ll go to your spouse first if you’re legally married. Then I’ll go to your children and parents next, regardless of whether you’re currently estranged from any one of them.”
The most important consideration for choosing someone is trust, he says. “For example, one of my patients told me she didn’t trust her husband or son with making these decisions; she trusted her daughter. In this scenario, she needed to sign a legal document to assign her daughter as her power of attorney.”
It is also crucial to communicate personal wishes to those with decision-making privileges, “so we don’t have to try and guess what this person would want,” says Dr. Sinha. “And I always remind these decision-makers that it isn’t about their own convenience or interest – it is about honouring what their loved one would have actually done or wanted.”
Knowing where to start
In addition to a perceived lack of necessity, the NIA report identified other barriers to estate planning. “Many people don’t know where to start,” says Dr. Sinha. “They think it is complicated, time-consuming and expensive.”
Yet due to digital tools becoming increasingly available, Canadians have a number of options. They can access wills and POA documents online as well as use online services that help guide them through the process, he says. “There is a free POA kit from the Ontario government, for example. It is straightforward to fill out and covers all the questions.”
The time to start is now, Dr. Sinha advises. “When people appreciate that there are significant benefits to estate planning and that it isn’t so complicated, then hopefully they will be inspired to become better prepared.”
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