Advance Care Directives in British Columbia (Representation Agreements)

A grandmother in Surrey in the early stages of Alzheimer's wants to make sure her oldest daughter — not her estranged son — will be the person speaking for her when she can no longer speak for herself. Her family doctor has assessed her as still capable of routine decision-making but less able to weigh complex legal documents. Her lawyer drafts a Section 7 Representation Agreement covering routine financial matters, minor and major health care (excluding refusal of life-supporting treatment), and personal care including admission to a care facility. She also signs a one-page Advance Directive that refuses CPR and ventilation if she enters an end-stage condition. Three years later, when the family is asked about treatment escalation in the ICU, the daughter has both documents to present and the hospital has clear authority to follow them.

That layered structure — a Representation Agreement plus an Advance Directive — is the standard BC approach to advance care planning. The province's Representation Agreement Act is unusual in Canada because it explicitly designs a lower-threshold instrument (Section 7) for adults whose capacity is in question. The trade-off is a more limited scope of decision-making authority.

This guide explains how the BC system works in practice. For wider context see our estate planning pillar and the related Ontario article on advance care directives.

The two statutes #

BC regulates substitute decision-making for personal care through two main statutes:

• The Representation Agreement Act, RSBC 1996, c 405 governs the creation of Representation Agreements (sections 7 and 9), defines representative powers, and sets the framework for monitors.^[1]
• The Health Care (Consent) and Care Facility (Admission) Act, RSBC 1996, c 181 governs informed consent to health care, the Advance Directive regime under sections 19.1–19.5, the temporary substitute decision-maker hierarchy, and admission to care facilities.^[2]

A capable adult also has the option of an Enduring Power of Attorney under the Power of Attorney Act for financial matters — covered in our separate is-POA-valid-in-all-provinces article.

Section 7 Representation Agreement (the standard agreement) #

The Section 7 RA, often called the "standard" agreement, was designed specifically to allow representation agreements for adults with limited capacity. Its key features:

• Lower capacity threshold. The adult does not need to "understand" in the formal legal sense; they need to communicate a desire to have a representative, show they trust the representative, and be aware of the nature of the relationship.^[4]
• Limited scope. Covers routine financial management, minor and major health care, and personal care including diet, dress, and care-facility admission. It does not cover refusal of life-supporting care, decisions about real property beyond routine matters, or financial decisions involving sale of major assets.
• Often requires a monitor. Section 7 agreements that authorize routine financial management usually require an appointed monitor (a third party who checks in on the representative), unless the representative is the adult's spouse or there are two co-representatives.

Section 7 is the right tool for many families dealing with dementia, developmental disability, or acquired brain injury where the adult has clear preferences about who should help but cannot meet the higher capacity test required for the broader Section 9 agreement.

Section 9 Representation Agreement (enhanced authority) #

A Section 9 agreement requires the adult to have the standard mental capacity to understand the nature and consequences of the document at the time of signing.^[5] In exchange, the representative gets broader authority:

• All routine and major health care
• Refusal of life-supporting care or treatment
• Consent to major medical procedures and end-of-life decisions
• Personal care decisions broader than the s.7 list

Section 9 is the rough equivalent of an Ontario Power of Attorney for Personal Care or an Alberta Personal Directive in terms of scope. Most healthy adult Canadians in BC who are completing standard estate planning will sign a Section 9 alongside their will and Enduring Power of Attorney.

Advance Directives under sections 19.1 and 19.5 #

Separately from the RA framework, BC's Health Care (Consent) Act allows a capable adult to make an Advance Directive — a written instruction directly to healthcare providers, made under section 19.1 and signed and witnessed under section 19.5.^[2] Key features:

• The adult must be 19 or older and capable of understanding the nature and consequences of the directive
• The directive must be in writing, dated, signed by the adult, and signed by two qualifying witnesses (or one if the witness is a lawyer or notary)
• It applies when no representative or TSDM is available, OR when the directive's instructions are clear and apply to the situation
• A healthcare provider must follow a valid advance directive that applies to the actual decision

The Advance Directive is the document that handles the "I do not want CPR / ventilation / artificial nutrition in this specific scenario" scenarios. It works best in tandem with a Representation Agreement: the Advance Directive covers anticipated scenarios; the RA covers everything else.

Temporary substitute decision-maker hierarchy #

If no Representation Agreement and no applicable Advance Directive cover a healthcare decision, the HCC Act provides a hierarchy of temporary substitute decision-makers (TSDMs):

1. Spouse
2. Child (19+)
3. Parent
4. Sibling
5. Grandparent
6. Grandchild
7. Anyone else related by birth or adoption
8. Close friend
9. More distant relative by marriage

The TSDM is selected by the healthcare provider for the specific decision, not appointed for ongoing decision-making. They must be 19+, capable, in contact with the adult in the past year, willing, and have no dispute with the adult.

The TSDM regime is the safety net. It works in routine cases but breaks down quickly when families disagree or when no close relative is available — which is why a Representation Agreement remains the better long-term planning tool.

The Nidus Registry #

BC has a unique resource that other provinces do not: the Nidus Personal Planning Resource Centre and Registry, a non-profit that operates an electronic registry for personal-planning documents.^[4] Adults can register copies of:

• Representation Agreements (sections 7 and 9)
• Advance Directives
• Enduring Powers of Attorney
• Nominations of Committee

Healthcare providers, lawyers, and family can search the registry to find documents when they are needed. Registration is optional and does not validate the document — but having a copy retrievable in an emergency from a single trusted source is genuinely useful, particularly for adults who travel or who are admitted to hospital unexpectedly.

How to choose: Section 7 vs Section 9 vs Advance Directive #

The decision generally follows the adult's current capacity and goals:

• Healthy adult, standard capacity — Section 9 Representation Agreement + Enduring POA + optional Advance Directive
• Adult with early dementia, partial capacity — Section 7 Representation Agreement; an Advance Directive while still clearly capable; review timing carefully
• Adult with significant cognitive impairment, no prior planning — limited options; usually a Section 7 RA if any capacity remains, otherwise a court-appointed committee under the Patients Property Act
• Adult who wants only direct medical instructions, not a representative — Advance Directive alone (less common, but possible)

The cost of getting this wrong is significant: without any of these documents, families have to apply to court to be appointed committee, a slow and expensive process. The right document signed while the adult is still capable saves enormous time and stress.

What we focus on at It's Simple Will #

It's Simple Will currently supports BC wills. Representation Agreement drafting is on the roadmap; for now, the platform points BC users to Nidus's free fact sheets and forms, the provincial government materials,^[3] and the Law Society of BC's lawyer-referral service for cases that need legal advice. The Life Discovery Kit captures the values and wishes information a representative will need so the conversation has a clear written reference.

For wider context see the estate planning pillar, the Ontario advance care directives article, and the is-POA-valid-in-all-provinces article. Start your BC will at the It's Simple Will app.