Advance Medical Directives

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Advance medical directives let you accept or refuse now certain health care treatments that you might need in the future. These directives will apply if you can’t consent to treatments.

Choose Now for Later

Advance medical directives let you choose now certain health care treatments that you might need later. These directives will be used if you need those treatments and you are not capable of accepting or refusing them at that moment. Choosing in advance is preserving your autonomy. It’s as if you were expressing your wishes at the time when the treatments are needed. Your choices must be respected.

Five Treatments That You Can Accept or Refuse

There are five treatments that you can accept or refuse in your advance medical directives:

  • cardiopulmonary resuscitation
    • (maneuvers to restart your heart and breathing, such as mouth-to-mouth)
  • ventilator-assisted breathing or breathing assisted by another device
    • (a machine to breathe for you if you cannot breathe on your own)
  • dialysis
    • (a machine to clean your blood if your kidneys can’t do it)
  • forced or artificial feeding
    • (“forced” means against your will; “artificial” means you can’t do it on your own)
  • forced or artificial hydration

Advance medical directives do not let you demand a particular health care treatment. For example, you can’t demand dialysis before being diagnosed. The medical staff will judge which treatment is appropriate for you in the circumstances.

What About Medical Aid in Dying?

You can’t ask for medical aid in dying in your advance medical directives because you must be able to consent when you ask for it.

When and How Do Advance Medical Directives Apply?

Advance medical directives apply only when

  1. you are unable to consent to treatment and
  2. you are in certain situations.

The authorized medical staff (doctors, nurses, etc.) consult your medical record or the Advance Medical Directives Register of the Régie de l’assurance maladie du Québec (RAMQ or health insurance board).The choices that you made in advance can then be respected. If the medical staff don’t respect your advance medical directives, one of your loved ones can ask a judge to make them.

1. You Must be Unable to Consent to Treatments

People can’t consent to treatment if they don’t understand:

  • the nature of disease;
  • the nature and purpose of the proposed treatment;
  • the risks and advantages of the proposed treatments; and
  • the consequences of not receiving these treatments.

A person’s ability to understand may be affected by the disease. For example, a person in a coma or who has advanced Alzheimer’s disease is unable to consent to health care treatments.

2. You Must Be in One of Three Situations

In addition to being unable to consent to treatment, you must be in one of the following three situations:

  • you suffer from a serious medical condition and are at the end of life;
  • you are in a coma (or permanently unconscious) and there is no chance that you will regain consciousness or get your intellectual abilities back; or
  • you have dementia that seriously affects your intellectual abilities and no improvement of your condition is possible (for example, advanced Alzheimer’s).

Two Ways to Make Advance Medical Directives 

You can make your advance medical directives either:

  • in a notarial deed made by a notary, or
  • by filling out the free “Advance Medical Directives in Case of Incapacity to Consent to Care” form available from the RAMQ and signing it in front of two witnesses.

The next step is to send your advance medical directives to the RAMQ to be recorded in the Advance Medical Directives Register. You can also give them to a health care professional to file them in your medical record.

Consent and Information Are Key

You must be able to consent when you make your advance medical directives. If you are incapacitated when you make them, your loved ones or a doctor could challenge them.

In addition, you must be well-informed about the treatments you are accepting or refusing in your advance medical directives. This means that you must understand the benefits and the risks of each treatment when you choose it.

Tell Your Loved Ones

Tell your loved ones about your advance medical directives. They will then know about your decisions, which can avoid emotionally charged situations if your advance medical directives need to be used.

You Can Change Your Mind

You can modify or cancel your advance medical directives as long as you can consent to health care treatments.

To modify your advance medical directives, you must write new ones.

To cancel them, you must fill out the “Revocation of Advance Medical Directives” form available from the RAMQ.

An Exception for Emergencies

If you are in an emergency that prevents you from following the rules to revoke your advance medical directives, you can still cancel them verbally. However, you must be able to consent to treatment at the time you cancel your directives.

What If You Don’t Have Advance Medical Directives?

Other documents can indicate your wishes in advance if you don’t have advance medical directives.

You could make a protection mandate or a living will. These documents allow you to give instructions about what health care treatments you do and don’t want if you become incapacitated.

If your advance medical directives are different from what you’ve said in your protection mandate, the advance medical directives take priority. The advance medical directives take priority even if your protection mandate is more recent.

For more information: Éducaloi’s article Protection Mandates: Naming Someone to Act for You

If you don’t have advance medical directives, a protection mandate, or a living will, the law says that someone close to you (a spouse or partner, a relative, a friend, etc.) can accept or refuse health care treatment for you. This decision must be made in your best interests. Talk to your loved ones about your preferences and your values. This information will guide them in the choices that they might need to make for you.

For more information: Éducaloi’s article Adults Who Can’t Make Medical Decisions on Their Own