Today’s Date: For: Naming a Substitute Decision Maker If you become ill - from disease or accident - there may come a time when you cannot think or speak clearly for yourself. If that happens, you will need someone to speak on your behalf and help doctors/healthcare providers make medical decisions for you. Who would you most like that person to be? Who do you trust? Who knows you the best? This person would be your substitute decision maker. (SDM) This person is: Their relationship to me is: Phone (day): Phone (evening): If that person was not available, the next person you trust and knows you well would be: Their relationship to me is: Phone (day): Phone (evening): **** Questions to reflect upon and discuss with the people above:

What gives you joy? What provides your life with meaning and fulfillment?

If you were to become ill, what would be important for others to know about you?

Do you have any spiritual or religious beliefs that would affect your decisions about the types of medical treatment you may want or not want? What are they?

What abilities are so critical to your life that you can’t imagine living without them?

Information: http://www.advancecareplanning.ca/ http://www.fraserhealth.ca/your-care/advance-care-planning/ 1-877-TALK-034 (1-877-825-5034) or email: advancecareplanning@fraserhealth.ca