Advance Directives

An advance directive is a plan made by a capable adult about future health care. It may record treatment preferences, name a person to make decisions if capacity is lost, or do both. In most Canadian jurisdictions, it becomes operative when the person is no longer capable of making the relevant decision or cannot communicate it, but the trigger and legal force depend on local legislation. Canada has no single advance-directive statute. The instrument may be called a power of attorney for personal care in Ontario, a representation agreement or advance directive in British Columbia, a personal directive in Alberta, or a protection mandate and advance medical directives in Quebec. These documents must not be treated as interchangeable. When a patient moves between provinces, the directive should be reviewed, updated if necessary, and made available to the receiving care team. A written preference is not automatically a current treatment order. For example, a directive may say, “I would not want prolonged mechanical ventilation,” while the chart contains no current order about resuscitation or intubation. The responsible clinician must interpret the...