If you become incapacitated and unable to make your own healthcare decisions, your healthcare providers may appoint someone to be your Temporary Substitute Decision Maker (TSDM). This person may not be the individual you would have selected to make decisions on your behalf, and they may be unprepared or ill-equipped to accept this responsibility. A TSDM does not have authority to make decisions about personal care (e.g., diet, grooming, clothing, spirituality, etc.), whereas a representative under a Representation Agreement does.

A Representation Agreement is a legally binding agreement that authorizes someone to make most personal and healthcare decisions on your behalf. An Advance Directive is a set of instructions authored by a capable adult for their healthcare provider or for their representative if they have named one in a Representation Agreement. It covers the type of health care that the adult consents to or refuses to consent to once they’re incapable of making decisions. 

A Representation Agreement is a legally binding agreement that authorizes someone to make most personal and healthcare decisions on your behalf. A Living Will (or ‘Expression of Wishes’), on the other hand, typically only includes your wishes related to end-of-life care (such as your desire for ‘heroic measures’ to sustain your life) and is considered to be only a morally binding rather than legally binding agreement in British Columbia. A Living Will can provide direction to the persons set out in your Representation Agreement on what kind of care you want, but it is preferable to include these instructions in a legally binding Advance Directive.