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Im Doris Barwick and Im the program medical director for end-of-life care and freezer health and in that role Id been involved with advance care planning initiatives at the local provincial and national level since 2004 so an advance directive is is my durable intent usually to to refuse a certain kind of healthcare so for instance I do not want to be resuscitated I do not want to be ventilated I do not want to be put on breathing machines I dont want kidney dialysis I dont want blood transfusions for religious or other reasons so there are some of these healthcare treatments that people have a durable intent to refuse and if they document that in an advance directive that absolutely needs to be followed its about autonomy the person has a right to say what happens to their own body and so as healthcare providers we need to look for evidence that a person has said no and then no means no so the role of a substitute decision-maker is to speak free for the person when that person