Procedure to express your wishes through advance medical directives

You are not obliged to express your wishes through advance medical directives. However, if you decide to do so, you have 2 options:

• The Advance medical directives in Case of Incapacity to Consent to Care form
• Notarial deed

1. Carefully read the information on advance medical directives so that you can freely make an informed decision.
2. Get the form from the Régie de l’assurance maladie du Québec (RAMQ): It is a personalized form, where your name and health insurance number have already been entered. It will also have a bar code that can be used to identify you. You can obtain the form in any of the following ways:
   • Download it online on the RAMQ website  (you will have to log in to your clicSÉQUR account or create an account to obtain your personalized form)
   • By telephone:
     • Montréal: 514 864-3411
     • Elsewhere in Québec: 1 800 561-9749 (toll-free) 
3. Complete the form, put your initials on each page, sign and date it.
4. Have it signed by 2 witnesses of full age.
5. Make your form accessible by either of the following methods:

   • Mail it to the RAMQ so that it will be filed in the Advance Medical Directives Register, at the following address:
     Régie de l’assurance maladie du Québec
     Case postale 16000
     Québec (Québec) G1K 9A2

     In order for your advance medical directives to be filed in the Register, make sure you send all pages of the form to the RAMQ, including the first 2 pages of general information.

     Once your form has been registered in the Advance Medical Directives Register, the RAMQ will send you a confirmation of registration by mail.

   • Hand it to your doctor or to a health professional so that they can file it in your medical record
   • Hand it to someone close to you, who will give it to a health professional if you become incapable of consenting to care. 

In case of physical incapacity, another person may complete, sign and date the form on your behalf, in your presence. A person who cannot read or write can also have another person to complete, sign and date the form.

In order to guide you in your reflection, it is possible to view a section of the Advance Medical Directives form. However, please note that you may not use this section to prepare your advance medical directives. Completing this online is impossible because each form is personalized with a unique barcode. To obtain the form, consult the Procedure section.

Notarial deed

If you wish, you can consult a notary, who will record your wishes in a notarial deed whose content is the same as that of the advance medical directives form prescribed by the Minister. If you so request, the notary will send the notarial deed to the RAMQ so that it will be filed in the Advance Medical Directives Register. You can also hand it to your doctor or a health professional for them to file it in your medical record. If applicable, inform those close to you of where you have filed your notarial deed.

The notary can check with you to see whether there is any conflict between wishes you have expressed elsewhere and your advance medical directives. He or she can also answer any questions you may have of a legal nature.

In order to be considered, advance medical directives must be accessible to health professionals. To make them accessible, advance medical directives issued using the prescribed form or by notarial deed must be filed:

• In the Advance Medical Directives Register; or
• In your medical record

Only advance medical directives brought to the knowledge of health professionals can be followed.

Advance Medical Directives Register

The Advance Medical Directives Register is a database storing forms duly completed by citizens and notarial deeds drawn up by notaries that have been sent to the RAMQ, which is the organization responsible for managing and operating the Register. The Register is accessible to health professionals, enabling them to consult people’s wishes regarding care.

Filing your form or your notarial deed in the Advance Medical Directives Register is the safest and fastest way of ensuring that your wishes will be accessible and respected in the event of your incapacity to consent to care.

Medical record

You are not obliged to file your Advance Medical Directives form or notarial deed in the register, although this is the recommended option. You can hand it to your doctor or to a health professional so that they can file it in your medical record. If you become incapable of consenting to care, the doctor will first consult the register and, if no directives are stored there, he or she will then consult your medical record.

Modifying your advance medical directives

You can modify your advance medical directives at any time provided that you are capable of consenting to care.

Simply complete a new Advance Medical Directives in Case of Incapacity to Consent to Care form, or consult a notary if you wish.

Depending on where your old advance medical directives are stored, you must either:

• Send the new form to the RAMQ so that it replaces the old one in the register, or ask your notary to send the modified notarial deed to the RAMQ; or
• Hand the form or notarial deed to your doctor or to a health professional so that they can make the change in your medical record

This new completed form or this new notarial deed will replace and cancel any advance medical directives you have previously formulated.

It is recommended that you update your advance medical directives when necessary, for example at particular stages in your life, in order to check whether you have changed your mind about your wishes regarding care.

Revoking your advance medical directives

You are the only person who can revoke (cancel) your advance medical directives.

To revoke your advance medical directives, whether they are filed in the Register or in your medical record, you must make a formal revocation using the Revocation of Advance Medical Directives form, also available from the RAMQ.

• If your advance medical directives are in the Register, you must send the Revocation of Advance Medical Directives form to the RAMQ.
• If your advance medical directives are stored in your medical record, you must send the Revocation of Advance Medical Directives form to a health professional, who will file it in your medical record.

Your revocation will be taken into account from the moment health professionals have access to it.

In case of emergency, if you are able to consent to care and you verbally express wishes different from those shown in your advance medical directives form or your notarial deed, the latter will automatically be revoked.

Contestation of your advance medical directives

Your advance medical directives can be contested. Only a court can invalidate (cancel) your advance medical directives, entirely or in part, at the request of your mandatary, tutor or curator, a physician, an institution or a person who can demonstrate having a special interest in you. The court can invalidate your advance medical directives:

• If it has reason to believe that you were not capable of consenting to care at the time you signed the Advance Medical Directives in Case of Incapacity to Consent to Care form
• If the directives do not correspond to your wish in the given situation

To prevent such a situation from arising, it is important to discuss your wishes with those close to you so that they are aware of your preferences and your values in the event that you become incapable of consenting to care. Informing those close to you of your wishes and explaining your thinking to them will reduce the likelihood of their contesting your advance medical directives.

Examples of situations involving incapacity to consent to care