Advance medical directives let you mention ahead of time whether you accept or refuse certain types of health care in certain situations. Medical staff must refer to this document and respect your wishes if you can’t make your own decisions about treatment.
This article explains: how to make advance medical directives, which treatments you can accept or refuse in directives, when directives can be used and how to change, cancel or challenge directives.
When Advance Directives Can Be Used
They can be used when the person who wrote them can’t make decisions about medical treatment. This can happen when a medical condition interferes with that person’s decision-making ability or ability to communicate.
Also, directives can only be used in one of these situations:
- The person is suffering from a serious and incurable illness and is at the end of life.
- The person is in a coma or is permanently unconscious and there is no chance of regaining consciousness.
- The person is suffering from dementia that severely affects mental functioning and there is no chance of recovery. This could happen, for example, if the patient has advanced Alzheimer’s disease.
Treatments You Can Accept or Refuse
In advance medical directives, you can only say you accept or refuse these treatments:
- CPR (restarting the heart and breathing)
- use of a ventilator (machine to assist in breathing)
- dialysis (keeping the kidneys functioning)
- forced feeding and hydration (feeding or giving liquids against the patient’s will)
- artificial feeding and hydration (using a tube, for example, when someone can’t eat or drink in the normal way)
You can’t ask for medical help to die in advance medical directives.
How to Make Advance Directives
There are two ways:
- with a notary
- using a free government form you sign in front of witnesses
You can send your directives to a government registry (list) kept by the Quebec health insurance board. You can also ask to have them put in your medical file.
You don’t have to put your directives in the government registry or your medical file. But it is a good idea to do this so medical professionals can easily find them. Also, if they are in the registry or your file, they must be respected.
Note that only adults (18 and over) can make these directives.
Also, you must be able to make informed decisions to make directives. This means you understand the document and its impact.
What Happens When a Patient Can’t Make Decisions
If the medical team (such as doctors and nurses) decides that a patient can’t make medical decisions, they must check to see if the patient made directives.
If there are directives in the government registry or the patient’s medical record, they must be followed.
If the medical team is not respecting the directives, a person close to the patient can ask a court to order them to follow the directives.
Advance medical directives can’t be used to force medical professionals to provide health care they consider inappropriate. For example, you can’t demand kidney dialysis if the medical team thinks it is not appropriate in the circumstances.
Test for Making Your Own Medical Decisions
To make their own decisions, patients must be able to understand the following:
- nature of their illnesses
- the treatment proposed
- the benefits and risks of the proposed treatment
- the risks of refusing treatment
Medical staff must consider whether the medical condition interferes with the patient’s understanding of this information.
Of course, patients are also not able to make their own decisions if they can’t express their wishes at all, because they are in a coma, for example.
Changing or Cancelling Directives
- To change them: You must make new ones.
- To cancel them: You must fill out the form Revocation of Advance Medical Directives, available from Quebec’s health insurance board (RAMQ).
Next, the new directives or the revocation form must be sent to the places where the previous advance medical directives were kept:
- to the RAMQ, if the old directives were in the government registry
- to the doctor, if the old directives were in your medical record
Note that, in an emergency, you can orally cancel directives if you are still able to make your own medical decisions.
Can Advance Directives Be Challenged?
Yes, certain people can challenge advance medical directives in court:
- someone showing a special interest in the patient (family, friends, etc.)
- a doctor from health-care institution treating the patient, or the health-care institution itself
There are two ways to succeed in challenging all or part of a patient’s directives:
- You show the patient did not have the capacity to make medical decisions when the directives were made. (So, the patient did not understand the document and its impact.)
- The directives don’t reflect what the person would have wanted in the situation the patient is in now.
Other Ways to Express Wishes About Health Care
Important! If wishes in a protection mandate contradict the directives, the directives apply.
If you have not made directives or expressed your wishes in advance another way, the law lets a person close to your (spouse, partner, relative, friend, etc.) accept or refuse health care on your behalf. The person acting for you must act in your best interests.