Volume 9, Number 1, November 1997

Editor's Forum

John B. Dossetor, O.C., M.B., B.Ch., Ph.D.
Editor

Welcome to our new publication, Health Ethics Today (successor to the Bioethics Bulletin). Health Ethics Today is a joint publication of the University of Alberta's Bioethics Centre and the Provincial Health Ethics Network, and will be distributed throughout Alberta and across Canada. We hope and trust it will continue to provide reflection on the current issues in healthcare, continuing the eight-year tradition of the Bioethics Bulletin.

The current issue focuses on the Personal Directives Act in Alberta and was planned to coincide with the release of the regulations for the Act. However, the Proclamation of the Act has now been scheduled for December 1, 1997. In our next issue we will comment on the regulations for this statute.

The Alberta Act is designed not only to provide for matters relating to future healthcare by appointing a personal agent and/or a directive for future health decisions, but also to cover many other decisions concerning the personal life of the maker, should he/she become incompetent at a later date. It is important to recognize this aspect. It distinguishes the Alberta Act from statutes in other jurisdictions regarding directives, advance health directives, living wills, etc., that are mostly concerned with healthcare decisions. The Alberta act is unique in being able to therefore, bridge the gap between decisions made regarding an incompetent person's finances (pursuant to the 1991 Enduring Power of Attorney for Fiscal Matters), and decisions made regarding healthcare matters. This gap includes decisions relating to such personal issues as accommodation, association, employment, movement, and so on. The duties and responsibilities of personal agents in Alberta can thus be quite wide in scope even though many critical decisions will be made in relation to health care. The Personal Directives Act expressly forbids and voids any instructions that request illegal care, such as physician-assisted suicide.

Families and other support persons have always provided a network of concerned individuals who are willing to help those whose capacity to decide has been eroded. What this Act should accomplish is empowerment of those who can best project and protect a person's prior autonomy beyond the time and point where the individual can express it for him or herself.

The Act is not intended for those individuals who have never gained personal decision-making capacity in their lives; that is, those who have developmental cognitive disability. Such individuals' best interests will continue to be governed by the Dependent Adults Act and its process of court-appointed guardianship for someone who does not have capacity. Indeed, in the absence of a Personal Directive, a court appointed guardian may still be required for previously competent persons.

What this Act does, is offer more options, widen horizons, and provide and protect personal autonomy. Unfortunately, in the Editor's opinion, the present version of this statute has dropped the proposed sections concerning recognition of the authority of family members by default, for those persons who failed to complete a personal directive. In the event that a personal agent has not been appointed, families will still not have statutory authority for decision-making for their incompetent loved one.

Health Ethics Today Credits

Associate Editors:

Al-Noor Nathoo, Donna J. Cain

Editorial Committee:

Vangie Bergum, Bashir Jiwani, Glenn Griener

Health Ethics Today is produced by the John Dossetor Health Ethics Centre, University of Alberta and the Provincial Health Ethics Network.

The opinions expressed in this newsletter are those of the authors only and not necessarily those of the John Dossetor Health Ethics Centre or the Provincial Health Ethics Network.