Advance directives offer greater clarity for patients and physicians
In circumstances where it has been determined that a patient is incapable (incompetent) of consenting to a particular medical treatment, the question as to who is authorized to make the decision will arise. In most provinces and territories, capable individuals can make an advance directive for their future care in the event that they become incapacitated or are unable to communicate their wishes.
Advance directives (sometimes called “living wills”) may contain explicit instructions relating to consent or refusal of treatment in specified circumstances. These are particularly relevant in long-term care settings. Ideally, individuals have clearly outlined their wishes for care and treatment, and these are known to healthcare providers and family members and appropriately documented.
Advance directives may also be used to appoint or designate an individual to make decisions about consent or refusal of treatment in the event the patient becomes incapacitated. In some jurisdictions, advance directives may be contained in powers of attorney for personal care (in Québec, called “mandate given in anticipation of incapacity”). The individual’s substitute decision-maker (SDM) must interpret the advance directive and is generally obligated to follow the directions in it, unless the SDM knows of other later wishes expressed by the patient.
Physicians will want to be familiar with applicable legislation or regulatory requirements in their jurisdiction regarding advance directives. Doctors should also be familiar with provincial medical regulatory authority (College) guidance on end-of-life issues, including advance directives.
For more information on advance directives, see the CMPA handbook, Consent: A guide for Canadian physicians and the article "Providing quality end-of-life care".