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FEATURE ARTICLE
specific clinical situations. The purpose of AMDs is
to avoid conflicts among family members, foster
agreement between the family and the care team
and reduce the risks of futile therapies when the
health care professionals are uncertain about the
value of providing certain kinds of treatment.
Although the law does not designate or limit the
kinds of medical care a person can refuse, only
five procedures are specified in advance medical
directives: cardiopulmonary resuscitation, assisted
respiration (by ventilator or other device), dialysis,
forced or artificial feeding and forced or artificial
hydration.
Furthermore, for health care professionals to
comply with the refusal to receive the medical care
specified in the AMDs, the person must be in one
of the three following clinical situations:
1) In an end-of-life situation due to a serious and
incurable illness
2) In a situation of severe and irreversible
cognitive impairment, for example, an
irreversible coma or permanent vegetative
state
3) In any other situation of severe and irreversible
cognitive decline
AMDs have binding legal weight only if their
author has become incapable of consenting to
care, regardless of the place or time that the care
is required by their physical state. Of course, the
attending health care provider must be aware of
the AMDs. Any other acceptance or refusal of care,
other than the five types of care stipulated in the
4 Ibid., ss. 51 to 64.
5 See online at: .
AMDs, must be expressed through another vehicle,
such as "living will" clauses inside a protection
mandate.
To be valid, AMDs must be expressed in a notarial
act separate from the protection mandate, or
before two witnesses, using the prescribed form.
They can be revoked at any time by any means,
and they can also be entered in the Advance
Medical Directives Register. The form can be found
on the Régie de l'assurance maladie du Québec
website.
5
AMDs can be given to the doctor, who
will put them in the person's medical file, or given
to a family member who can give them to the
doctor when the time comes.
In the event of conflict between the wishes
expressed in advance medical directives and those
expressed in a protection mandate, the AMDs
take precedence. AMDs cannot be used to ask for
medical care in dying, and the author is presumed
to have obtained the information required to make
a free and informed decision. The courts can also
order the wishes expressed in AMDs to be upheld.
In sum, Patrice could leave AMDs regarding the
five procedures covered by law and only applicable
if he was in one of the three specified clinical
situations. He could complete these AMDs with
living will clauses inside his protection mandate.
After all these explanations, Patrice is relieved to
know that, despite the strict legal framework, he has
so many options for ensuring the legal recognition
of his wishes concerning end-of-life care and the
comfort care that will protect his dignity.
