Talking about advance medical directives with the person I am caring for

Expressing one’s advance medical directives

Advance medical directives (AMD) is a written document in which a person of legal age and capable of consenting to care indicates in advance the medical care they will accept or refuse to receive should they become incapable of providing their own consent in specific clinical situations.

For example, by checking a box on the written document, the person refuses or consents to cardiopulmonary resuscitation in an end-of-life situation. You can consult an excerpt from the Advance Medical Directives in Case of Incapacity to Consent to Care form for other examples.

To express your advance medical directives, you must:

• meet certain requirements;
• follow a procedure.

Talking about advance medical directives with the person I am caring for

The choice of whether or not to discuss advance directives is a very personal one. Some people wish to retain their power of decision or avoid complex choices for those around them. Though it may be difficult for you, it could be important to open up a dialogue so that you know and better understand the wishes of the person you are caring for.

Here is a discussion guide for talking about advance medical directives with the person you are caring for:

1. What are their wishes? The person you are caring for wants to be fully involved in the care decisions that affect them, and wants to be sure that their wishes are respected. You also want to talk about your own needs as a caregiver;
2. What are their own fears? Is it fear of pain, of loneliness, of losing touch? And what are yours?
3. What are the obstacles? What do you both want to be reassured about? What are your own apprehensions? For example, anticipating the death of the person you are caring for can be painful, and could increase your feelings of guilt, leaving you anxious about mourning;
4. What can you do about it? Talk to your doctor or a member of the Caregiver Support team. You may also want to understand the difference with the protection mandate. Please note that it is not possible to request medical aid in dying under an AMD.

Mini glossary of advance medical directives

• Clinical situations. AMDs are expressed for situations in which an individual is at the end of life or suffers from a serious and incurable disease, an individual’s cognitive functions are severely impaired resulting in an irreversible comatose state or permanent vegetative state, or an individual’s cognitive functions are severely impaired resulting in major cognitive impairment with no possibility of improvement;
• Treatments covered. Clinical care that can be accepted or refused is that which is necessary to prolong life, but which does not improve the individual’s medical condition, such as cardiopulmonary resuscitation, ventilator-assisted ventilation, dialysis, force-feeding and hydration and artificial feeding and hydration.