No one wants to think about it when they're healthy, and that's precisely the only time you can do it. The advance medical directives allow you to specify in advance which medical treatments you accept or refuse, for the day when you can no longer express your wishes yourself. They have real legal force—and a narrower scope than most people realize.
On this page
- What Are Advance Directives?
- The Situations and Care Covered
- What They Do Not Cover
- How to Write Them
- Their Strengths and Limitations
- Guidelines, scope of practice, level of care: Don't confuse them
- Modify or Revoke
- Myths and misconceptions
- Frequently asked questions
What Are Advance Directives?
These are care preferences expressed in advance, in writing, by a person who is competent, in the event that they become unable to give consent. They take the form of consent to or refusal of specific treatments in specific clinical situations.
A rejection, not an order
This is the nuance that is most often overlooked. A patient may refuse treatment in a binding manner; however, a patient cannot demand that an inappropriate treatment be administered. The right to refuse is absolute, but the right to receive treatment is not—no form creates an obligation to treat against clinical judgment.
The Situations and Care Covered
The official form matches three clinical situations with five treatments. It is a fixed grid, and that is what makes it so effective: no interpretation is necessary.
| Clinical situation | What she describes |
|---|---|
| End of Life | A serious, incurable medical condition at an advanced and irreversible stage |
| Severe and irreversible impairment of cognitive functions | Coma or a vegetative state deemed irreversible |
| Another severe and irreversible impairment of cognitive functions | Advanced-stage dementia, with no possibility of recovery |
For each one, a decision is made regarding: cardiopulmonary resuscitation, mechanical ventilation, dialysis, forced feeding and hydration, and artificial feeding and hydration.
To remember
- The guidelines apply only if you become unable to give consent—as long as you are capable, the decision is yours.
- They cover three clinical situations and five treatments, not all medical decisions.
- A refusal that is legally binding; one cannot be required to undergo treatment that is not medically indicated.
- Medical assistance in dying cannot be requested using this form.
- You must be of legal age and competent at the time of writing.
- They may be amended or revoked at any time as long as one is competent.
What They Do Not Cover
- Medical Assistance in Dying. It cannot be requested in advance using this form; it is a separate process with its own conditions and guidelines.
- Common Decisions. Surgery, antibiotics, or a change in treatment are not the focus.
- Non-medical questions. Property, funerals, and organ donation are covered in other documents.
- Situations that fall outside the three specified cases. Apart from these cases, the usual rules regarding substituted consent apply.
These documents are best prepared with a professional who is familiar with your situation. The online consultation allows us to discuss it remotely, and the appointment scheduling at our service locations in Quebec allows you to schedule an in-person appointment. Organizations can find the details in our offers for businesses.
How to Write Them
There are two recognized forms, both of which have the same legal standing but vary greatly in terms of accessibility.
- The official form, completed and signed in the presence of two witnesses, and then filed with the advance medical directives registry. This is the recommended procedure: the registry can be consulted by healthcare professionals when the need arises.
- The Notarized Deed, executed before a notary, and also entered in the registry.
The Trap of the Document in a Drawer
Even perfectly drafted advance directives are useless if they’re just sitting at home: in an emergency, no one will go looking for them. Filing them with the registry is what makes them effective. In addition, it’s a good idea to give a copy to your loved ones and let your doctor know about them.
Their Strengths and Limitations
| Question | Answer |
|---|---|
| Are professionals required to comply with them? | Yes, they are legally binding |
| Can a family member contradict them? | No—they take precedence over the family's opinion |
| Do they apply as long as I am able to work? | No—my word at that moment still stands |
| Can we deviate from it? | Only in exceptional cases, which must be justified and documented |
| Do you need a notary? | No, the official form is sufficient |
The third line is worth noting: nothing that is written in advance can be used against a person who is still capable. The guidelines remain dormant until the person becomes incapable.
Guidelines, scope of practice, level of care: Don't confuse them
There are three different tools circulating under similar names, and confusing them leads people to believe they are protected when they are not.
| Tool | What is it used for? |
|---|---|
| Advance Medical Directives | Expressing one's own refusal or consent to specific medical care |
| Protection Order | Appoint someone to make decisions for you |
| Level of Care | Clinical discussion documented in the medical record, updated as the condition progresses |
The three complement each other: the guidelines specify what to do, the mandate specifies who should do it, and the level of care translates all of this into the current clinical situation.
Modify or Revoke
- The change can be made at any time, as long as the person is capable.
- A new form filed with the registry replaces the previous one.
- Revocation may be made in writing; in an emergency, a clear expression of intent by a person with legal capacity is sufficient.
- It is a good idea to review your advance directives after a major diagnosis or a change in your personal circumstances.
Myths and misconceptions
«It's only for the elderly or the sick.»
False. The situations in question—serious accidents, comas—can occur at any age. You need to be mentally capable to write these documents, so the best time to do so is beforehand.
«It allows you to request medical assistance in dying»
False. This form does not allow for that. It is a separate process with its own requirements.
«My family may decide otherwise»
False. Valid advance directives take precedence over the opinions of loved ones. In fact, that is one of the reasons for drafting them: to spare the family from having to make an impossible decision.
«To refuse treatment is to be abandoned»
False. Refusing life-sustaining treatment does not preclude palliative care and pain relief, which are always provided.
«A document from our own office is sufficient»
Nuanced. A letter expresses an intention and may be taken into account, but it does not have the binding force of an official form or the visibility of the registry.
Frequently asked questions
Do you need a doctor to fill out the form?
No, it's not required. However, it is recommended: understanding what each treatment entails often changes the answers.
Does it cost anything?
The form and its filing with the registry are free of charge. The notarized procedure involves fees.
How can I tell if my instructions have been properly filed?
A confirmation is sent after registration. It is best to keep it and check it periodically.
Are they recognized anywhere other than in Quebec?
The system is specific to Quebec. Elsewhere, different rules apply, and the registry may not be searchable.
Can I write one for my minor child?
No. You must be of legal age and competent. For minors, the rules regarding parental consent and the best interests of the child apply.
What if I change my mind at the hospital?
As long as you are of sound mind, your current wishes take precedence over any previous document.
Sources
- Government of Quebec — Advance Medical Directives
- Quebec Health Insurance Board — Registry
- Quebec College of Physicians — End-of-Life Care
- Éducaloi — Consent and End-of-Life Care
- Public Trustee of Quebec
- Order of Nurses of Quebec
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