La Cible

Août 2019

La Cible, magazine officiel de l’IQPF, est destinée aux planificateurs financiers et leur permet d’obtenir des unités de formation continue (UFC). Chaque numéro aborde une étude de cas touchant les différents domaines de la planification financière.

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27 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.

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