Representation Agreements (15:V)

The RAA has a significant historical connection to the developmental disability community. A primary reform goal was to give legal recognition to substitute decision-makers, and status for informal helpers to adults that are family and friends. Another primary change was a shift of focus toward support for capacity rather than assessments of incapacity, as the latter can take away an individual’s personal autonomy.

Refer to Representation Agreements and Supported Decision Making

Representation Agreements (RA) are governed by the RAA. RAs are an instrument by which an individual can proactively plan for the possibility of future incapacity, by appointing another person to make decisions on their behalf. RAs are the primary method by which adults in BC can plan for future health care substitute decision making. An RA can also be used to give legal authority to a person’s supportive decision-maker—a person appointed under the RA to help the adult make their decisions, not necessarily to make their decisions for them. As the capacity test for creating an RA is lower than the test for creating a POA, a person with limited cognitive capacity may have the capacity to create an RA.

Some RAs allow a routine financial substitute decision making. This includes all s 7 RAs, as well as some s 9 RAs executed prior to September 1, 2011 which authorize a representative to make financial support arrangements as described in s 9(1)(f) of the repealed provisions of the RAA (see s 44.2 of the current RAA). After September 1, 2011, a s 9 RA may only be made concerning personal and health care decisions.

In the BC health care system, health care providers must speak directly to an individual in order to inform them about health care choices and consequences. An adult with capacity has the right to give or refuse consent for treatments. Due to illness, accident or disability, an individual needing health care may not be capable of understanding advice, making informed decisions, or providing meaningful consent to proposed treatment. If the adult has previously enacted an RA, then the Representative(s) will be able to give or refuse consent on behalf of the capable adult, acting as appointed substitute decision-maker(s) to make decisions according to the incapable adult’s personal wishes, values and beliefs.

An individual making an RA may be in a vulnerable position due to family dynamics, cognitive challenges, discriminatory beliefs about people with disabilities, or other factors. Vulnerability may create more opportunities or potential for abuse. Students must be aware of indicators of abuse and follow procedures that will help them to notice abuse. If possible, the student should meet the client alone and ensure that the client truly wishes to create an RA and give powers to the potential representative. The student must ensure that the client understands and appreciates the meaning of the RA and its effects. Students should take detailed notes of the client interview, and should consider multiple meetings with the client to ensure that the client understands and appreciates the process and the document.

Students should refer to their Supervising Lawyer if there is any doubt that the client understands and appreciates the RA. Also note that, according to s 3.1 of the amended RAA, an adult must not be required to have an RA as a condition of receiving any good or service.

RAs may come into effect immediately or upon future incapability. The vast majority of registered RAs come into effect immediately. Students should be aware that the first duty of a Representative is to consult and abide by the personal wishes, values and beliefs of the adult, at all times.

A. Types of Representation Agreements

Under the current RAA, there are two levels of RAs that an adult can choose to create, named for the section which governs them: s 7 RAs and s 9 RAs. Both types of RAs allow the adult to select any or all areas of decision-making created by the statutory section in which he or she will authorize the Representative to act on his or her behalf.

1. Section 7 Representation Agreements

Section 7 RAs designate a substitute or supportive decision-maker to make personal care decisions, major and minor health care decisions for the adult, and routine legal and financial decisions.

These health care decisions cover the majority of health and personal care related choices that an individual can make over the course of their life. The list of decisions includes decisions regarding:

• personal care, including where and with whom the adult is to reside;
• consent to treatment;
• medication;
• minor OR major surgery;
• diagnostics and tests;
• palliative care; and
• living arrangements of the adult.

A s 7 RA may also allow the Representative to take care of routine financial affairs of the adult, including:

• paying bills;
• receiving and depositing a pension and other income;
• purchasing food and other services necessary for personal care; and
• making investments.

See RA Act Regulation 2(1) for full list of what constitutes routine financial affairs. This section of the regulation is repeated at Appendix H. The concept of routine management of the adult’s financial affairs excludes, for example (s 2(2), RA Reg):

• (a) using or renewing the adult's credit card or line of credit or obtaining a credit card or line of credit for the adult;
• (b) subject to subsection (1) (h), instituting on the adult's behalf a new loan, including a mortgage;
• (c) purchasing or disposing of real property on the adult's behalf;
• (d) on the adult's behalf, guaranteeing a loan, posting security or indemnifying a third party;
• (e) lending the adult's personal property or, subject to subsection (1) (v), disposing of it by gift;
• (f) on the adult's behalf, revoking or amending a beneficiary designation or, subject to subsection (1) (r), creating a new beneficiary designation;
• (g) acting, on the adult's behalf, as director or officer of a company.

The creation of a s 7 RA does not require the services of a lawyer. LSLAP is able to draft s 7 RAs for clients, as can a notary. However, students must be aware that a s 7 RA for the adult does not permit a Representative to make health care and personal decisions that involve decisions to refuse health care necessary to preserve life, or to physically restrain, move or manage the adult.

If there is a conflict between an enduring POA and a s 7 RA which includes routine management of financial affairs, the enduring POA will take priority.

2. Section 9 Representation Agreements

Section 9 RAs designate a substitute decision-maker for significant and sometimes very personal or more controversial health or personal care decisions, including:

• where the adult is to live and with whom, including whether the adult should live in a care facility;
• whether the adult should work and, if so, the type of work, the employer, and any related matters;
• whether the adult should participate in any educational, social, vocational or other activity;
• whether the adult should have contact or associate with another person;
• whether the adult should apply for any licence, permit, approval or other authorization required by law for the performance of an activity; *day-to-day decisions on behalf of the adult, including decisions about the diet or dress of the adult;
• giving or refusing consent to health care for the adult, including giving or refusing consent in the circumstances specified in the RA to specific kinds of health care, even where the adult refuses to give consent at the time the health care is provided; and
• physically restraining, moving and managing the adult and authorizing another person to do these things, if necessary to provide personal care or health care to the adult

Students should be aware that a representative under s 9 RA must not do the following, unless expressly provided for in the RA:

• give or refuse treatment in accordance with s 34(2)(f) of the HCCFA.
• make arrangements for the temporary care and education of the adult’s minor children, or any other person who is cared for or supported by the adult; or
• interfere with the adult’s religious practices.

S 34(2)(f) pertains to refusing substitute consent to health care necessary to preserve life (s 18, HCCFA.) In a s 9 RA, if a Representative is provided the power to give or refuse consent to health care for the adult, then the Representative may give or refuse consent to health care necessary to preserve life (s 9(3), RAA). Some other health decisions are also excluded from potential powers, e.g. “sterilization for non-therapeutic purposes” (s 11(2), RAA).

The creation of a s 9 RA no longer requires the services of a lawyer. LSLAP is able to draft s 9 RAs for clients. However, refer to your Supervising lawyer to clarify the appropriate scope and purpose of the RA: which type of RA appropriately meets the needs of the client?

Prior to September 2011, a s 9 RA could include broad financial powers, equivalent to those given in a POA. The new PAA says this broad authority in an RA is now treated as if it were an enduring POA, and the Representative must follow the requirements under the PAA to use these powers (s 44.2 Transitional Provision).

B. Who Can Be a Representative?

Section 5(1)(a) of the RAA specifies that an individual who is 19 years of age or older can be appointed as Representative unless that person is:

• providing personal care or health care services to the adult for compensation, unless the caregiver is a spouse, adult child, parent, grandparent, an adult brother or sister or any other adult relation by birth or adoption; or
• working as an employee of a facility in which the adult resides and through which the adult receives personal care or health care services.

The Public Guardian and Trustee can also be named as a Representative. According to s 5(1)(c), a credit union or trust company can only have authority to make (limited) financial decisions listed in a s 7 RA. A credit union or trust company cannot make decisions regarding health care or personal care.

Under s 5(2) of the RAA, an adult can also name more than one Representative either:

• a) over different areas of authority; and/or
• b) over the same area of authority, in which case, the Representatives must be unanimous in exercising their authority.

Section 5(4) requires that all Representatives for RAs made under section 7 complete a certificate in the prescribed form (see Appendix I).