Representation Agreements in BC — Who Makes Medical Decisions If You Can't?
A representation agreement is arguably the most important estate planning document you've never heard of. It decides who speaks for you when you can't speak for yourself.
Key Takeaways
- A representation agreement covers health care decisions during incapacity — separate from a will or POA
- Section 7 (standard) vs Section 9 (enhanced) — different powers, different requirements
- Without one, a statutory hierarchy determines who decides — which may not be who you'd choose
- Section 9 can include end-of-life treatment decisions
- Every adult should have one, regardless of age or health
What a representation agreement does
A representation agreement is a legal document under BC's Representation Agreement Act (RAA) that names someone — your representative — to make decisions about your health care and personal care if you become incapable of making those decisions yourself.
This is different from:
- A will — which only takes effect after death
- An enduring power of attorney — which covers financial decisions, not health care
A representation agreement covers what happens while you're alive but unable to communicate or make decisions — after a stroke, during surgery complications, with advanced dementia, or after a serious accident.
Section 7 vs Section 9
BC has two types of representation agreements, and the differences matter:
| Feature | Section 7 (Standard) | Section 9 (Enhanced) |
|---|---|---|
| Health care decisions | Routine health care | All health care, including major decisions |
| Refuse treatment | Cannot refuse life-sustaining treatment | Can refuse life-sustaining treatment |
| Personal care | Where you live, who you see, daily activities | Same, plus broader authority |
| Financial | Routine financial matters only | Not covered (use a POA) |
| Capacity to create | Lower threshold — can be made even with some cognitive decline | Full mental capacity required |
| Witnessing | Two witnesses (with restrictions) | Must be witnessed by a lawyer or notary |
Which one do you need?
Most people should have a Section 9 agreement if they want their representative to have full authority over health care decisions, including end-of-life treatment. If you have strong feelings about life support, resuscitation, or palliative care, Section 9 is how you ensure those wishes are followed.
Section 7 is important for people who may already have some cognitive decline — it can be created with a lower capacity threshold, making it the only option for someone in the early stages of dementia who hasn't yet made a representation agreement.
Some people create both: a Section 7 as a fallback and a Section 9 for comprehensive coverage.
What happens without a representation agreement
If you become incapable and don't have a representation agreement, BC's Health Care (Consent) and Care Facility (Admission) Act provides a statutory hierarchy of temporary substitute decision-makers:
- Your spouse (including common-law after 2 years)
- An adult child
- A parent
- A sibling
- Any other relative
This sounds reasonable — but problems arise when:
- Family members disagree about treatment
- The person highest on the list isn't the person you'd choose
- You're estranged from family members who technically have authority
- You're in a newer common-law relationship that family disputes
- Nobody knows your wishes about end-of-life care
A representation agreement removes all ambiguity. You choose your representative. You can express your values and wishes. Done.
Choosing your representative
Your representative should be someone who:
- Knows your values — especially about quality of life, pain management, and end-of-life care
- Can advocate for you — will speak up to medical professionals and family members
- Is available — can respond quickly if decisions need to be made
- Can handle stress — these decisions are emotionally difficult
- Will follow your wishes — even if they personally disagree
You can name an alternate representative in case your first choice is unavailable.
Advance directives and wishes
A representation agreement names who decides. You can also document what you want — your values, preferences, and specific instructions about treatment. While BC doesn't have a formal "living will" statute, you can include your wishes in the representation agreement or in a separate document that your representative keeps.
Common topics to discuss with your representative:
- Your feelings about life support and mechanical ventilation
- Resuscitation preferences (CPR, defibrillation)
- Tube feeding and artificial nutrition
- Pain management — do you prioritize comfort over extending life?
- Where you'd want to receive care (home, hospital, hospice)
- Religious or cultural practices that matter to you
- Organ donation wishes
How to create a representation agreement
- Section 7: Must be signed by you and witnessed by two people. Witnesses cannot be your representative, your representative's spouse, or certain care providers.
- Section 9: Must be signed by you and witnessed by a lawyer or notary. The lawyer/notary must certify that you appeared capable.
Most estate lawyers prepare a representation agreement as part of the standard three-document package (will + POA + representation agreement). See: How Much Does a Will Cost in BC?
Need help with a representation agreement?
A BC estate lawyer or notary can prepare all three essential documents — will, power of attorney, and representation agreement.
Frequently asked questions
What is a representation agreement in BC?
A legal document that names someone to make health care and personal care decisions if you become incapable. Separate from a will (after death) and POA (finances).
What's the difference between Section 7 and Section 9?
Section 7 covers routine health care and requires less capacity to create. Section 9 gives broader powers including refusing life-sustaining treatment and requires full capacity plus lawyer/notary witnessing.
Who makes medical decisions if I don't have one?
A statutory hierarchy applies: spouse, adult child, parent, sibling, then other relatives. Disagreements may require a court application.