How to Talk to Your Family About Advance Care Planning in Manitoba

Most people would rather do almost anything than sit down with their family and talk about what should happen if they can't speak for themselves medically. The conversation feels premature, morbid, or unnecessarily heavy — right up until the moment it's urgently needed and hasn't happened.

In Manitoba, the person you name as your health care proxy under The Health Care Directives Act is legally bound to make decisions based on your documented wishes. But a written directive can't cover every possible medical scenario. Your proxy will inevitably face decisions your document doesn't explicitly address, and when that happens, they'll be relying on what they know about your values, your priorities, and your definition of a life worth living. That knowledge only comes from conversation.

When to Start

There's no perfect moment, but some are better than others. A new diagnosis, a hospital stay, retirement, or the death of someone close are all natural entry points — they make the topic feel relevant rather than abstract. Planning a trip, updating a will, or entering a personal care home also work because they're already administrative in nature.

Avoid starting the conversation during a crisis. If a parent is being admitted to the ICU, the conversation you're having isn't advance care planning — it's emergency decision-making under pressure. The two produce very different outcomes.

Start with Values, Not Medical Procedures

Jumping straight to "do you want CPR?" tends to shut conversations down. Most people don't have a clinical framework for answering that question, and the directness can feel confrontational.

Start with broader questions:

• What does a good day look like for you?
• If your health declined, what abilities or experiences would you most want to preserve?
• Is there a point at which you'd rather focus on comfort than on trying to extend your life?
• Who do you trust to make medical decisions for you, and why?

These questions get at the values that inform specific treatment choices. Once you understand that someone prioritizes being able to recognize family members over physical survival, the CPR conversation becomes much more natural.

Cover the Manitoba-Specific Details

Manitoba's clinical system uses three Goals of Care levels that translate broad wishes into actionable medical orders. Walking through these together gives everyone a shared vocabulary:

Level C (Comfort Care) — all clinical interventions focus on comfort and symptom management, excluding CPR and other life-prolonging measures. The priority is quality of life and dignified end-of-life care.

Level M (Medical Care) — medical tests and treatments are used to manage illness, but resuscitation and life support are excluded. This level fits people who want active treatment for treatable conditions but don't want to be kept alive artificially.

Level R (Resuscitative Care) — all appropriate medical interventions, including attempted CPR, intensive care, and mechanical ventilation.

Most families find it helpful to talk through specific scenarios: "If I had advanced dementia and developed pneumonia, would I want IV antibiotics? Hospital transfer? Or comfort care at home?" These concrete examples are easier to discuss than abstract principles.

Talk to Your Proxy Directly

If you've named a health care proxy — or you're thinking about who to name — they need to be part of this conversation. Being named as a proxy without understanding the person's wishes is an enormous burden. Some proxies describe it as the hardest thing they've ever had to do, precisely because they weren't sure what the person would have wanted.

Be specific with your proxy about:

• Which treatments you'd accept and which you'd refuse in different scenarios
• Whether your written directive is your absolute ceiling (nothing beyond what's listed) or a starting point (your proxy can authorize additional treatment if they believe you'd want it)
• How you feel about palliative sedation, hospice care, and organ donation
• Any religious or cultural values that should guide decisions

Keep It Short and Repeatable

This doesn't need to be a single two-hour kitchen-table summit. In fact, shorter conversations spread over several weeks tend to produce better results. Bring up one scenario at a time. Let family members process and come back with questions.

Some families find it easier to start the conversation in writing — sharing an article, filling out a worksheet together, or responding to a prompt. The Manitoba Advance Directive & Living Will Kit includes a Goals of Care Reference Card that families can review together, turning an intimidating clinical framework into a structured discussion guide.

After the Conversation

The conversation only matters if it's documented. Update your health care directive to reflect what you discussed. Make sure your proxy has a copy and knows where the original is stored. If you keep your directive in an ERIK kit on your refrigerator, verify it reflects the latest version of the conversation.

Your wishes will evolve over time — a conversation you have at 50 may look very different from one at 75. Build in a habit of revisiting the topic every few years, or whenever a major health event changes the landscape. The goal isn't to have the conversation once. It's to keep it current.

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