Advance Directives and Goals-Of-Care Conversations

A patient with advanced heart failure says, 'I do not want machines keeping me alive,' while the family asks the team to do everything. The next nursing action is not to choose a side or search for a single form. Clarify what the patient understands, whether the patient can make the current decision, what the statement means in treatment terms, and who is legally authorized to consent if capacity is absent. Advance care planning prepares for future decisions; it does not give consent to a treatment that has not yet been proposed. A goals-of-care conversation connects the patient's values and acceptable outcomes with realistic treatment choices. A directive or portable order is useful only when the team can retrieve it, interpret it, reconcile it with current orders, and identify the correct consent source. Canadian law is provincial and territorial. The Ontario Health Care Consent Act provides the legal example used here; its substitute decision-maker hierarchy must not be assumed to apply unchanged across Canada. The nurse's safety task is consistent across settings: protect the patient's voice when capacity is present,...