What my healthcare wishes are and how will I ensure they are known?
Incapacity: What will occur if I am unable to consent to care by myself?
In the case of a person of full age who is incapable of giving consent to care required by their state of health and in the absence of Advance Medical Directives (further explained below), the treating team will turn to the person’s next of kin for support in the decision-making process and to obtain a consent.
The person authorized to consent to care for the person is:
- The person’s mandatary, tutor or curator; or
- The person’s spouse (married, civil union of de facto); or
- A close relative or a person who shows a special interest in the person (such as their children).
The person who consents to care for another person is bound to act in the sole interest of that person, complying, as far as possible, with any wishes the latter may have expressed.
It is possible for any individual to identify a person who will consent to care for them by making a document known as a Protection Mandate (further explained below).
What are Goals of Care discussed in the healthcare environment?
Determining the Goals of Care refers to a process by which the treating team and the patient (and/or the person authorized to consent to care for the patient) determine together the most appropriate level of medical intervention for the patient, based on the patient’s medical condition, wishes the patient may have expressed (in a Protection Mandate, in Advance Medical Directives, or in a Living Will) and the patient’s current wishes. This Goals of Care process requires members of the treating team, particularly the physician, to engage the patient (and/or the person authorized to consent to care for the patient) in a discussion upon admission to the hospital or even during an emergency department assessment. Once concluded with the patient’s active input (and/or the person authorized to consent to care for the patient) it will be documented in the patient’s medical chart, becoming an important tool in supporting the provision of appropriate medical care. The Goals of Care of a patient may include a “Do Not Resuscitate” order.
What is a Protection Mandate?
This document is a mandate in which a person may name someone to speak on their behalf and to make decisions for them in case that the person becomes incapable of doing so. Said mandate is made in anticipation of the person’s incapacity to take care of themselves and/or to administer their property.
In a Protection Mandate, a person may express wishes regarding the provision of health care and services in different circumstances. The mandatary shall comply, as far as possible, with said wishes.
The performance of the Protection Mandate is conditional upon the occurrence of the incapacity and homologation by the court upon application by the mandatary designated in the act.
A Protection Mandate can be made by a notarial act en minute or in the presence of witnesses.
What are Advance Medical Directives?
Advance Medical Directives are a way to consent to or refuse, in advance, some medical interventions in specific clinical situations, i.e. in the event that the person is facing an end of life situation or suffers from severe and irreversible cognitive impairment. A person may not request medical aid in dying in such directives.
Advance Medical Directives must be made on the form prescribed by the Minister of Health and Social Services. The list of interventions that can be consented to or refused in advance is on the form prescribed by the Minister of Health and Social Services.
Advance Medical Directives have the same value as wishes expressed by a person capable of giving consent to care. They are binding, which means that health professionals that have access to them are obliged to comply with them. In case of inconsistencies between a person’s Protection Mandate, Living Will and Advance Medical Directives, the latter prevail.
Advance Medical Directives are given by notarial act en minute or in the presence of witnesses.
A person may request that their Advance Medical Directives be recorded in the register established by the Minister of Health and Social Services. The register can be virtually accessed by physicians and nurses across the Province of Québec. Advance Medical Directives can also be given by a person to be put in their medical chart.
What is a Living Will?
A Living Will is a document in which the patient can indicate wishes for care in anticipation of their incapacity to consent to care. There is no legal framework applicable to a Living Will, unlike a Protection Mandate and Advance Medical Directives.
For more information and documentation:
Legal Educational Capsule from Educaloi (in French)
Legal Educational Capsule for Seniors from Educaloi (in French)
- Mandate in Anticipation of Incapacity
- Homologation of Mandate for Incapacity
- Consent to Care
- Living Will
- Curatorship for Adults
- Public Curator and Protecting the Incapacitated
- Wills and funerals
The information contained on this page is not a legal opinion and does not constitute a recommendation. This page is solely intended to provide the public with general information on how health care and services are provided in case of one’s incapacity to consent. For any questions regarding your health, you should consult a physician. For any legal questions, you should consult a lawyer.