Personal Directive vs. Enduring Power of Attorney: Who Makes Decisions and Who Pays?

Opening a solo dental hygiene practice means you’re not just a clinician, you’re also the business owner, decision-maker, and often the only person legally responsible for your operations. While many new Independent Dental Hygienists focus on equipment, policies, and marketing, legal planning is an often-overlooked but essential part of protecting both yourself and your practice.

Two key documents to understand are the Personal Directive and the Enduring Power of Attorney (EPA). While terminology varies slightly by province, the concepts are consistent across Canada.

What Is a Personal Directive?

A Personal Directive (called a Representation Agreement in BC or Power of Attorney for Personal Care in Ontario) is a legal document that outlines who can make personal and healthcare decisions if a person becomes unable to do so themself.

The person they appoint is called their Agent.

The Agent may have authority to make decisions related to:

• Medical and dental care

• Living arrangements

• Personal services

• End-of-life wishes

What Is an Enduring Power of Attorney?

An Enduring Power of Attorney (EPA) focuses on financial and legal decisions. The word enduring means the document remains valid if a person loses mental capacity.

The Attorney (the person they appoint) may manage:

• Business bank accounts

• Rent or lease payments

• Payroll or contractor payments

• CRA obligations

• Insurance premiums

• Equipment financing

• Personal bills and investments

Why Both Documents Matter

A Personal Directive and an Enduring Power of Attorney serve different but complementary roles:

• Personal Directive = healthcare and personal decisions (Ex. what dental hygiene procedures are ok to provide for your client)

• Enduring Power of Attorney = financial and business decisions (Ex. the person who agrees to pay for the dental hygiene services provided)

These documents create continuity and protect:

• Your patients

• Your business reputation

• You, as a healthcare provider

It's important when dealing with clients who lack capacity to make their own decisions, that you are well aware of who legally has the right to make decisions and who has the right to pay for the services that have been agreed to. Often, the same person may have both PD and EPOA rights for your client. In the case of elders or special needs clients, it is also important to know the goals of care that will also guide your intervention decisions should the client have a medical emergency while they are with you. When a PD Agent reaches out to arrange a dental hygiene appointment, it is good practice to have them sign as a PD Agent and/or EPOA so that you have the information should there be investigation into your care delivery. The PD and EPOA should be willing to present the official document that shows they have authority to make decisions and pay for the services you provide.