A11 HEALTH CARE DIRECTIVES ACT Advances in medical research and treatments have, in many cases, enabled health care professionals to extend lives. Most of these advancements are welcomed, but some people fear that life can be prolonged regardless of the quality of life or the patient's wishes. In Manitoba, The Health Care Directives Act acknowledges and respects that people have the right to accept or refuse medical treatment. A health care directive, also referred to as a living will, allows patients to make choices about their future medical care. As allied health care providers, EMS personnel should make an effort to identify patients where an advance directive may be in effect. If such a directive is identified, the instructions it contains regarding treatment should be respected. In situations involving advance directives where EMS personnel are unclear how to proceed (disagreement with family members, proxy revokes directives, or other similar circumstances), they should follow compliance with the proxy s wishes as per the Health Care Directives Act (section 13, paragraph 3). Function of the Directive A health care directive is a written document that allows patients to express their specific instructions as to the level and type of medical treatment they want performed if they are ever unable to indicate their wishes. This may occur due to mental incompetence or inability to communicate. A directive also allows the patient to appoint another person, called the proxy, to make health care decisions on their behalf if they are unable to do so. Legal Requirements To be valid, a health care directive must be in writing, signed, and dated. This form acts as a guide for providing the proper information in a health care directive, but it is not a requirement. A valid directive may be any written document that is signed and dated. The directive will be binding on health care professionals and the patient s proxy, provided the instructions are consistent with accepted medical practices. The person making the directive must be at least 16 years of age and be able to understand the consequences of his or her decision. Once completed, a health care directive records only the person s current wishes and can be changed at any time. The Manitoba Government has prepared an acceptable health care directive form. A copy is included in this appendix. Before Completing a Directive The decisions a person makes in a health care directive are very important and should never be entered into lightly. When a person makes a directive, it is important for them to discuss their intentions with their doctor and other health care professionals. This will help ensure that the person s wishes are clearly understood. It may also be useful for the person to talk to their lawyer to understand any legal issues involved. For example, if the person spends time outside Manitoba, they may wish to ask their lawyer about the validity of their living will in another jurisdiction. Living wills from other jurisdictions may be valid in Manitoba if they meet the requirements described above. Health Care Directives Act August 2003 Page A11-1
The person should discuss their intentions with close family members and their potential proxy so they are fully aware of the person s wishes. This ensures that they will know a health care directive exists and can refer to it if necessary. Choosing a Proxy As it is impossible to anticipate every circumstance, it can be important to choose a proxy. The proxy will make medical decisions on the person s behalf if they are unable to do so. The proxy s decisions will be based on the specific instructions in the person s health care directive and his or her personal knowledge of the person s wishes. Choosing a proxy is a very personal decision and should be made with care. The person or people chosen should be trusted, such as close friends or family members. They should be willing to accept the responsibility. The person should ensure that those chosen are well aware of the person s wishes. It is often wise to choose more than one person as a proxy in case the first choice is unable to act. If more than one person is chosen, the directive should indicate whether they are to act jointly or consecutively. If acting jointly, people named will make decisions together as a group. The directive should also indicate whether decisions will be by consensus or majority. If acting consecutively, the second proxy named will make decisions only if the first person named is unable to do so. Changing a Directive The health care directive may be changed at any time and done as often as desired. Opinions about certain types of treatment may change over time, and should be reflected in the person s current health care directive. Also, medical technology is constantly changing and improving. These improvements may affect the person s decisions. In general, a health care directive should be reviewed at least every couple of years. To change a health care directive, a new document should be prepared. Any former directive should be destroyed to ensure instructions are clear to those who are asked to follow them. Safekeeping a Directive The health care directive should be kept in a safe place but still be accessible to family, friends, or other health care personnel if they need to refer to it. It should not be kept in a safety deposit box since it cannot be obtained quickly. The person s primary care doctor should keep a copy in the medical records. It is also wise for the proxy (proxies) to have a copy and to know how to obtain the original if necessary. Some may wish to have their directive reduced in size and laminated to carry in a wallet. EMS personnel should keep this in mind when determining if an advanced care directive exists. Health Care Directives Act August 2003 Page A11-2
Manitoba Health Care Directive/Directive en matière de soins de santé (Please type or print legibly/prière de dactylographier ou d écrire en caractères d imprimerie) This is the Health Care Directive of/directive de Name/Nom Address/Adresse City/Ville Province/Province Postal Code/Code postal Tel./Tél. (204) PART 1 Designation of a Health Care Proxy/ 1 re Partie Désignation de mandataire You may name one or more persons who will have the power to make decisions concerning your medical treatment when you lack the ability to make those decisions yourself. If you do not wish to name a proxy, you may skip this part. Vous pouvez autoriser une ou plusiers personnes à prendre les décisions concernant vos traitements médicaux au cas où vous deviendrez inhabile à les prendre vous-même. Si vous préférez ne pas désigner de mandataire, passez immédiatement à la 2e partie. I hereby designate the following person(s) as my Health Care Proxy:/Je désigne par les présentes la ou les personnes suivantes à titre de manadataire: Name of Proxy 1/Mandataire n 1 Address/Adresse City/Ville Province/Province Postal Code/Code postal Tel./Tél. ( ) Name of Proxy 2 (Optional)/Mandataire n 2(faculatif) Address/Adresse City/Ville Province/Province Postal Code/Code postal Tel./Tél. ( ) If I have named more than one proxy, I wish them to act: consecutively jointly. (Initial or check your choice. If you do not, Proxy 2 will be deemed to act only if Proxy 1 cannot or will not act.) Je désire que les mandataires que j ai nommés, s il y en a plus d un, agissent séparément, ou conjointement. (Paraphez ou cochez à l endroit choisi. À défault de choix, le manadataire n 2 sera réputé agir séparément en cas d incapacité du mandatiare n 1.) I place no restriction on the ability of my Health Care Proxy to make medical decisions on my behalf when I lack the capacity to do so for myself, except as follows: Health Care Directives Act August 2003 Page A11-3
La présente autorisation que j accorde à mon ou à mes mandataires de prendre des décisions d ordre médical en mon nom lorsque je suis incapable de la faire moi-même n est assortie d aucune restriction, sauf de la suivante: PART 2 Treatment Instructions/ 2 e Partie Traitement In this part, you may set out your instructions concerning medical treatment which you do or do not wish to receive and the circumstances in which you do or do not wish to receive that treatment. REMEMBER your instructions can only be carried out if they are set out clearly and precisely. If you do not wish to express any treatment instructions, you may skip this part. Dans la présente partie, vous pouvez donner vos directives en ce qui concerne les traitements médicaux que vous désirez ou ne désirez pas recevoir et décrire les circonstances dans lesquelles ces traitments peuvent ou non vous être administrés. SOUVENEZ-VOUS que vos directives ne peuvent être suivies que si elles sont claires et précises Si vous préferez ne pas donner de directives au sujet de vos traitements médicaux, passez immédiatement à la 3e partie. Health Care Directives Act August 2003 Page A11-4
PART 3 Signature and Date/3 e Partie Signature et date In order to be valid this Health Care Directive must be dated and signed by you. No witness is required. Vous devez dater et signer la présente formule pour qu elle soit valide. Aucun témoin n est nécessaire. Signature/Signature Date/Date If you are unable to sign yourself, you may have someone sign on your behalf. In that case, the substitute must sign in your presence and in the presence of a witness. The proxy or the proxy s spouse cannot be the substitute signer or witness. Si vous êtes dans l incapacité de signer personnellment, vous pouvez demander à quelqu un d autre de le faire à votre place. Dans ce cas, votre remplaçant doit signer en votre présence et en présence d un témoin. Les mandataires et leur conjoint ne peuvent pas signer à titre de remplaçant ni de témoin. Name of substitute/nom du remplaçant Address/Adresse Signature/Signature Date/Date Name of witness/nom du témoin Address/Adresse Signature/Signature Date/Date Health Care Directives Act August 2003 Page A11-5