Only persons of full age who are capable of giving consent to care can issue advance medical directives. These directives are used only when the doctor determines that the person’s state of health renders them incapable of consenting to care.
Clinical situations covered
Advance medical directives apply in specific clinical situations that are not necessarily emergency situations. These clinical situations are ones that health professionals are increasingly encountering and in which they question the pertinence of providing certain treatments, even though they are necessary to maintain life. These situations are as follows:
- End-of-life situation:
- When a person is suffering from a serious, incurable medical condition and is at the end of life.
- Situation of severe, irreversible loss of cognitive functions:
- When a person is in a comatose state that is judged irreversible, that is, that they are permanently unconscious and confined to a bed, without any possibility of regaining consciousness.
- When a person is in a permanent vegetative state, that is, they are unconscious, but some reflexes are maintained, such as the capacity to open and close the eyes, or reaction to pain.
- Another situation of severe, irreversible loss of cognitive functions:
- When a person is suffering from severe, irreversible cognitive impairment, without any possibility of improvement, for example Alzheimer’s disease or another type of dementia at an advanced stage.
The treatments covered by advance medical directives are life-sustaining treatments that may be necessary to prolong your life. Consequently:
- Not giving these treatments, or stopping them, can shorten your life.
- Agreeing to these treatments may prolong your life, without hope of improving your medical condition.
The table below sets out the treatments covered by advance medical directives.
|Treatments||Description of treatments|
|Cardiopulmonary resuscitation||Medical intervention designed to restart heart function and respiration of a person whose heart has stopped and whose lungs have ceased to function. Cardiopulmonary resuscitation includes mouth-to-mouth resuscitation, chest compression (cardiac massage), defibrillation (treatment of abnormal heart contractions) and a ventilator (or respirator).|
Use of a device to provide respiration to a person who has become incapable of breathing.
Medical intervention to clean the blood when the kidneys can no longer do so.
|Force-feeding and hydration|
Feeding and hydrating a person against their will. Refusal is expressed by words or gestures.
|Artificial feeding and hydration|
Feeding and hydration of a person who can no longer feed themselves or drink using a tube passed into the stomach or by a catheter introduced into a vein.
Note that medical aid in dying cannot be requested in advance medical directives.
Whatever your wishes are, the care necessary to ensure your comfort and relieve your pain will be provided by health professionals.
If you have expressed a refusal to receive certain treatments in the event of incapacity, but you have consented to organ and tissue donation, the doctor will give you the care necessary to maintain your vital functions, which are required for organ donation.