Advance Care Planning in Saskatchewan: What to Do and in What Order

What Advance Care Planning Actually Involves in Saskatchewan

Advance care planning in Saskatchewan isn't one document — it's a sequence of legal, clinical, and logistical steps that work together. Miss one, and the others can fail when they matter most. A health care directive that never gets uploaded to MySaskHealthRecord is invisible to the emergency team. An Enduring Power of Attorney signed with invalid witnesses is unenforceable at the bank. A Goals of Care Designation that contradicts the directive creates confusion in the ICU.

Saskatchewan's framework is governed by three separate statutes — The Health Care Directives and Substitute Health Care Decision Makers Act, 2015 for medical decisions, The Powers of Attorney Act, 2002 for financial and personal decisions, and The Adult Guardianship and Co-decision-making Act for when neither of the first two were set up in time. Understanding the order these documents should be completed in saves time and prevents the gaps that trip up families during a crisis.

Step 1: The Health Care Directive

This is the foundational document. Saskatchewan residents aged 16 or older with mental capacity can create a health care directive that records treatment preferences and names a proxy to make medical decisions if they lose capacity.

What it covers: Treatment wishes (resuscitation, ventilation, tube feeding, comfort care), proxy appointment, and organ donation preferences.

What it doesn't cover: Financial decisions, property management, daily living choices, or Medical Assistance in Dying (MAID cannot be pre-authorized through a directive — federal law requires a conscious request at the time of administration).

Signing rules: The person signs and dates the directive themselves. No witnesses required. If someone else signs on the person's behalf because they're physically unable to, one independent witness is mandatory, and neither the proxy nor the proxy's spouse can serve as that witness or signer.

Proxy selection: Name a primary proxy and at least one alternate. Avoid naming joint proxies unless there's a strong reason — if joint proxies disagree, the decision is made by majority vote. If a majority cannot be reached, the first-named proxy's decision is legally binding.

Step 2: The Enduring Power of Attorney

The health care directive handles medical decisions. The Enduring Power of Attorney handles everything else — bank accounts, investments, bill payments, property management, and non-medical daily living choices like housing and dietary preferences.

Under Saskatchewan's 2015 legislative amendments, an Enduring POA automatically appoints the attorney as both the property attorney and the personal attorney unless the document explicitly limits the scope.

Witnessing is mandatory and strict. Unlike the health care directive, an Enduring POA must be witnessed. Two options exist:

• Lawyer route: A practicing Saskatchewan lawyer witnesses the signing and completes a Form D Certificate of Legal Advice.
• Non-lawyer route: Two independent adult witnesses who are not family members of either the person or the attorney. Both sign a Form E Non-Lawyer Witness Certificate.

Getting the witnessing wrong is one of the most common POA failures in Saskatchewan. A family member who serves as a witness, or a single non-lawyer witness instead of two, invalidates the entire document.

The Homesteads Act limitation: Even a perfectly executed Enduring POA cannot authorize the attorney to sign spousal consent to sell the family home under Section 6(4) of The Homesteads Act, 1989. If the non-owning spouse loses capacity, selling or refinancing the homestead requires a court application. This is a gap in the POA's coverage that families should plan around, not discover during a crisis.

Step 3: Digital Registration

Saskatchewan has integrated advance care planning with the provincial health system more thoroughly than most Canadian provinces.

MySaskHealthRecord: Upload a PDF of the signed health care directive to the Health Care Directive Widget in the MySaskHealthRecord portal. Enable sharing with the provincial eHR Viewer. This makes the directive visible to attending physicians, nurse practitioners, pharmacists, and emergency room staff at any Saskatchewan hospital.

Registration requires a Saskatchewan Health Card and an SGI driver's licence. The service is free.

What to check after uploading: Confirm the document displays as "shared" in the portal. An uploaded file with sharing disabled is stored but invisible to clinical teams — functionally useless during an emergency.

Step 4: Physical Storage — The Yellow Sleeve

Digital access helps in hospitals. It doesn't help paramedics responding to a home emergency. The Saskatchewan Health Authority's Yellow Sleeve program fills that gap.

Place a printed copy of the signed health care directive inside the standard yellow plastic sleeve provided by the SHA. Attach it to the outside of the refrigerator. EMS personnel across Saskatchewan are trained to check the fridge for the yellow sleeve during a home crisis.

Also carry an SHA Proxy Wallet Card in the person's wallet or purse — it identifies the named proxy for situations outside the home.

Step 5: Goals of Care Designation

The health care directive is a legal document. The Goals of Care Designation (GCD) is a clinical medical order. The directive tells the proxy what the person wants. The GCD tells the medical team what to do right now.

GCD levels typically range from full resuscitation to medical management only to comfort care (such as the C1/C2 imminently dying designations). The primary physician translates the directive's instructions into the appropriate clinical order, which goes into the patient's permanent electronic medical chart.

Schedule this conversation with the family physician after the directive is signed. The goal is alignment — the legal directive and the clinical order should say the same thing. A directive specifying "no aggressive treatment" paired with a GCD coded for full resuscitation creates confusion during exactly the kind of emergency the documents were meant to resolve.

What Happens Without Any of This

If someone loses capacity with no health care directive and no Enduring POA:

• Medical decisions fall to the statutory nearest-relative hierarchy: spouse first, then adult children (eldest decides if they disagree), then parents (custodial preferred), then siblings (whole blood preferred). The person's actual preferences are unknown.
• Financial decisions freeze entirely. Bank accounts, bills, property — nothing moves without a court-appointed guardianship. The application to the Court of King's Bench requires two medical assessments confirming incapacity, legal representation, and ongoing financial reporting to the Public Guardian and Trustee. Statutory guardian fees run 2.5% of monthly receipts and 2.5% of payments when the court hasn't set a specific fee.
• The 30-day trigger: If no next-of-kin applies for estate administration within 30 days of death, the court can grant default administration to the Public Trustee.

Every step in the advance care planning sequence exists to prevent one of these outcomes.

The Complete Sequence

1. Sign the health care directive (treatment preferences + proxy)
2. Execute an Enduring Power of Attorney (proper witnessing with Form D or Form E)
3. Upload the directive to MySaskHealthRecord and enable eHR Viewer sharing
4. Set up the Yellow Sleeve on the refrigerator
5. Distribute copies to proxy, alternate proxy, and family physician
6. Schedule and complete a Goals of Care Designation with the physician
7. Review annually or after any major life event (diagnosis, marriage, divorce, death of a proxy)

The Saskatchewan Advance Directive & Living Will Kit walks through each step with fillable worksheets, a signing-day checklist covering both documents' witnessing rules, and a proxy selection worksheet — everything organized in the sequence above.

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