Palliative Care Before the Final Chapter Why Young Canadians Should Learn About ACP

By Nikhil Srivalsan, Student, University of Calgary

Advance care planning is not a prediction about dying. It is a practical way to make our values known while we are well enough to speak for ourselves.

A conversation we tend to postpone

Ask a group of people in their twenties what they are planning for, and the answers may include a career, a move, a relationship, travel, graduate school, or the next rent payment. Ask who would speak for them if an accident or sudden illness left them unable to communicate, and the room may become much quieter.

That silence is understandable. For many of us, planning for future health-care decisions feels like something reserved for a much later stage of life. Palliative care, too, is often imagined as care that begins only when someone is approaching death. That perception misses an important part of what palliative care actually is.

According to Health Canada (2026), palliative care is a holistic approach for people of any age living with serious illness. It can support quality of life, relieve symptoms, help with important decisions, and support patients and caregivers throughout illness, beginning as early as diagnosis. This means palliative care can be relevant well before the final days of life.

Advance care planning is life planning

Advance care planning, or ACP, is related to palliative care but is not limited to people who are seriously ill. At its core, ACP asks a very human question: What matters to me if I cannot speak for myself?

Advance Care Planning Canada (2026) describes ACP as relevant to people across the lifespan and states that it is “for everyone, whether young or old, healthy or living with health challenges.” That is an important reframing. ACP is not an expectation that something bad will happen. It is preparation for the possibility that, at some point, another person may need to understand and represent our values.

Health Canada (2023) similarly notes that advance care planning can be done while a person is healthy and can continue after a diagnosis of serious illness. It involves reflecting on values and wishes, communicating the kind of future health and personal care one would want if unable to speak, and identifying the person who may need to make decisions on one’s behalf.

Why should a healthy young adult care?

For a young person, the most immediate value of ACP may not be a document. It may be the conversation. Imagine being temporarily unable to communicate after a serious collision. Who knows what matters to you? Who would you trust to speak for you? Would that person know how you think about independence, cognition, comfort, family, spirituality, recovery, or acceptable trade-offs when choices become difficult?

These questions are personal, and that is precisely why they are worth discussing before a crisis. Research on surrogate decision-making in critical illness has documented how demanding the role can be for family members and other substitute decision-makers. A systematic review and meta-analysis by Bibas et al. (2019) describes the substantial responsibility placed on surrogates when patients cannot make or communicate decisions, and notes that the process can be associated with psychological distress.

ACP cannot remove every difficult decision, but it can give the people we trust a clearer compass. The goal is not to script every future medical choice. It is to communicate enough about our values, priorities, and preferences that someone else can represent us more faithfully if needed.

Palliative care is not the same as “giving up”

Normalizing ACP also requires correcting a related misconception: palliative care does not automatically mean that treatment has stopped or that death is imminent. Health Canada (2026) explains that palliative care can support people from the time of diagnosis and can help patients and caregivers throughout the course of serious illness.

This matters for younger Canadians because the language of palliative care can feel remote or frightening when it is encountered for the first time during a crisis. Learning about it earlier can help us understand palliative care as an approach centred on the person, including comfort, quality of life, decision-making, relationships, and the goals that matter to that individual.

The conversation does not have to be perfect

One reason people postpone ACP is the belief that they need to know exactly what they would want in every possible medical circumstance. They do not. Preferences can evolve as health, relationships, responsibilities, and life experiences change. ACP is therefore better understood as an ongoing conversation than as a one-time prediction about the future.

A first conversation can be simple: “If something happened and I could not speak for myself, I would want you to know what matters most to me.” From there, the discussion can become more concrete. Advance Care Planning Canada (2025) encourages people to think about their values and wishes, consider who would speak for them, and communicate those wishes before they are needed.

The legal details matter, too. Health Canada (2023) notes that every province and territory has legislation related to advance care planning or substitute decision-making, but terminology, forms, and requirements differ across Canada. People should therefore use the guidance that applies in their own province or territory.

For Albertans, Alberta Health Services (n.d.) states that all adults can benefit from advance care planning because an unexpected event or change in health can happen. Its guidance also emphasizes that planning ahead helps family members and health-care providers understand a person’s wishes.

What young Canadians can do this week

ACP does not need to begin with a lawyer’s office, a hospital bed, or a formal family meeting. It can begin over coffee. Choose one person you trust. Explain why you are raising the subject. Ask what matters to them, too. Consider who should speak for you if you could not speak for yourself, and learn what your province or territory requires to formally identify that person.

The point is not to make young adults preoccupied with illness. It is to make conversations about values, caregiving, and future decision-making less foreign. We routinely prepare for unlikely but consequential events in other parts of life. Health-care decision-making deserves the same thoughtful preparation.

Before the crisis

Young adulthood is full of planning for futures we hope to reach. Advance care planning asks us to prepare, briefly and thoughtfully, for a future we hope never arrives.

That is not pessimism. It is a form of care for ourselves, for the people who may one day have to speak for us, and for the health-care professionals trying to honour the person behind the patient. Perhaps the most useful shift is to stop treating these conversations as the final chapter. They belong much earlier in the story.

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References

Advance Care Planning Canada. (2025, March 3). Frequently asked advance care planning questions. https://www.advancecareplanning.ca/acp-basics/faq/
Advance Care Planning Canada. (2026, April 21). April 16 is Advance Care Planning Day in Canada. https://www.advancecareplanning.ca/programs/acp-day/
Alberta Health Services. (n.d.). Frequently asked questions: Advance care planning and goals of care. Retrieved August 14, 2026, from https://www.albertahealthservices.ca/info/Page15938.aspx
Bibas, L., Peretz-Larochelle, M., Adhikari, N. K. J., Goldfarb, M. J., Luk, A., Englesakis, M., Detsky, M. E., & Lawler, P. R. (2019). Association of surrogate decision-making interventions for critically ill adults with patient, family, and resource use outcomes: A systematic review and meta-analysis. JAMA Network Open, 2(7), e197229. https://doi.org/10.1001/jamanetworkopen.2019.7229
Health Canada. (2023, November 23). Palliative care: Preparing and deciding. https://www.canada.ca/en/health-canada/services/health-services-benefits/palliative-care/preparing-deciding.html
Health Canada. (2026, March 20). Palliative care: Overview. https://www.canada.ca/en/health-canada/services/health-services-benefits/palliative-care.html
Practical resources for readers
Advance Care Planning Canada: https://www.advancecareplanning.ca/
Health Canada, Palliative care: https://www.canada.ca/en/health-canada/services/health-services-benefits/palliative-care.html
Alberta Health Services, Advance Care Planning and Goals of Care: https://www.albertahealthservices.ca/info/page9099.aspx