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Palliser Primary Care Network

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Difficult Conversations

senior-conversation.jpgDiscussing the end of life is never easy.  We often avoid thinking about mortality, out of fear of the emotional upset. However, if these conversations occur and steps are taken, we can ensure that a person's wishes are known and followed. Without difficult conversations, wishes can be unclear. Decisions made may be based upon our own wants and needs, rather than theirs.

There are two important documents related to these conversations: an Advanced or Personal Directive (AD/PD) and a Goals of Care Designation or green sleeve (GOCD). These documents serve different functions.

  • Advance Directive: The AD is a patient's voice if they are temporarily or permanently unable to speak on their own behalf (for example, if a person was to have a stroke and be temporarily unable to communicate, or perhaps be unconscious). The AD designates an individual to make personal (non-financial) decisions, such as living arrangements, treatments options and more.

  • Goals of Care Directive: The GOCD is different. It is related to decisions that are made following a drastic change in health status – for example, if an individual collapses or they stop breathing. Should they receive CPR? Would they want to be in the ICU?


Here are some questions/considerations to aid these conversations:

  1. How much do you understand your current health and medical conditions?

  2. What fears do you have about your future?

  3. What goals do you have for yourself?

  4. How do you feel about quality of life versus quantity (suffering vs. time)?

Take the plunge and have the conversations. It may not be the easiest thing to do, but it really is for the best. Green Sleeves are available through family physicians.  Further information regarding advance care planning can be found at .

This article was submitted by Aurora Cyganik-Barker, RN with Dr. Rinaldi