On choices around death, Quebec offers a cautionary tale

Categories: Care and Opinion.

Most everyone would like to have some say about how they die. And there’s a legal tool that allows that to be theoretically possible.

Advance medical directives (AMDs) are documents that allow individuals to state, ahead of time, whether they would accept or refuse specific “lifesaving” medical interventions if they become incapacitated. These documents have many benefits: They can help avoid unwanted, unnecessary procedures near end-of-life; they can stave off ugly family fights; and they help health-care providers avoid a lot of stress and second-guessing.

But what should AMDs look like? How can we ensure that people’s wishes are respected but also that the directives are flexible enough to cope with the unexpected?

Those questions are tackled in a fascinating new paper from the Institute for Research on Public Policy, entitled Improving Advance Medical Directives: Lessons from Quebec.

The authors, Louise Bernier and Catherine Régis – law professors from Université de Sherbrooke and Université de Montréal, respectively – note that when Quebec legalized medically assisted dying in 2015, the move was part of a sweeping reform of end-of-life legislation that also included new rules on AMDs.

To prepare an advance medical directive in Quebec, you simply go online and fill out a form that allows you to say if, in case of incapacitation, you will accept or refuse five specific medical interventions: cardiopulmonary resuscitation, ventilator-assisted respiration, dialysis, artificial feeding and hydration.

The checklist is legally binding. And while the authors say that’s a good thing, it can also be problematic.

Consider this scenario: A 70-year-old suffers a stroke and is left in a permanent vegetative state. Her AMD makes it clear that she doesn’t want any intervention – not even artificial feeding and hydration. But her son, who lives abroad, asks medical staff to keep her alive for a week so he can come back and say goodbye. What happens?

The answer, as with many things in Canadian health care: it depends on where you live.


To read the full article, please follow this link: https://www.theglobeandmail.com/opinion/article-on-choices-around-death-quebec-offers-a-cautionary-tale/

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