There are different ways to make one’s wishes known when it comes to refusing or accepting medical care.
Advance medical directives are written instructions in which you express in advance your acceptance or refusal to receive certain medical care in specific clinical situations. In the event that you are no longer able to consent to care, health care professionals would be obligated to abide by your instructions.
Notarized protection mandates
The notarized protection mandate may contain certain provisions about the conditions surrounding the end of life. Unlike the advance medical directives, these end-of-life provisions in the protective mandate are not as readily available to health professionals. In addition, these care wishes expressed in a protection mandate do not constitute advance medical directives within the meaning of the Act Respecting End-of-Life Care.
Should the wishes expressed in the mandate and those expressed in the advance medical directives differ, the latter prevails.
Advance medical directives
Advance medical directives are written documents that express in advance the acceptance or refusal of care in specific clinical situations.
Your advance medical directives will be applied if you find yourself in one of the following situations and are no longer able to give your consent:
- You are at the end of your life and suffer from a serious and incurable disease
- Your cognitive functions are severely impaired, resulting in an irreversible comatose state or a permanent vegetative state
- Your cognitive functions are severely impaired, resulting in a state of advanced dementia with no possibility of improvement (e.g., Alzheimer’s disease or other types of advanced dementia)
Care that may be refused or accepted:
- Cardiopulmonary resuscitation
- Ventilator-assisted breathing
- Forced or artificial feeding
- Forced or artificial hydrationforcée ou artificielle.
Advance medical directives are registered with the Régie de l’assurance maladie du Québec (https://www.ramq.gouv.qc.ca/en/citizens/health-insurance/issue-directives-case-incapacity). In the event that you are no longer able to consent to care, health care professionals would have ready access to the records and would be obligated to abide by your instructions.
Advance medical directives may be made before witnesses using the form prescribed by the Minister of Health and Social Services. However, the law also provides that your notary may record your directives in a notarial act. This solution has undeniable advantages. Contrary to the form, a notarial act is difficult to contest.
Note: A doctor cannot be asked to administer a drug or substance to obtain medical aid in dying. The Act Respecting End-of-Life Care prohibits advance consent.
By making your advance medical directives before a notary, you can be confident you have the information you need to make the right choices.
The notary is a legal professional. Their role is to advise you in the preparation of the legal document that will contain your advance medical directives.
- Ensures that you have received all the necessary information before preparing your instructions and that you are well informed of the consequences of refusing care
- Discusses your situation and needs with you, without taking the place of a health care professional
- Verifies that there is no conflict between your wishes expressed elsewhere and your advance medical directives
- Takes the time to answer your questions
- Forwards your instructions to the Advance Medical Directives Register and your physician for inclusion in your medical record at your request
The notary can direct you to different resources if you need more information about the care you want to receive, including the impact on longevity and quality of life.
Finally, the notarial act is ideal since its authenticity gives it a high degree of reliability.
The notarial act guarantees:
- The person’s identity
- That the person is of full age and capable of giving consent to or refusing certain medical care
- That consent is informed and given freely and without undue pressure