Living Wills: Expressing Wishes for Health Care

Since 2015, there is a new way to express certain health care wishes in advance: advance medical directives. Éducaloi will soon be adding a new article on advance directives. Advance directives are not the same as living wills.
luriiSokolov / iStock / Thinkstock

Your aunt is 90 years old. She is in the hospital after suffering a stroke and can't communicate with doctors.

As her only living relative, you get a call from the hospital. The doctor asks whether your aunt should be revived if her heart stops. 

In these kinds of situations, a document called a living will can provide valuable information about someone's wishes.

 

What is a living will?

A living will is a written document with your wishes regarding medical care. For example, you can indicate that you don't want to be kept alive using a respirator. The document will only be used if you can't make your own decisions or express yourself. A living will helps guide people who might have to make decisions for you.

 

Is a living will legally recognized?

In Quebec, there is no law specifically on living wills.  However, they do have legal value because Quebec law says people have the right to agree to or refuse medical care.  A living will is an extension of this right:  it lets you express your wishes in advance about care you want or don't want.

Also, the law says that people who can agree to care on your behalf must consider any wishes you expressed in the past. 

 

Are there special requirements to follow to make a living will?

There are no special legal requirements regarding the document itself. You can even write it in the form of a simple letter.

But it can be a good idea to date it and sign it. You can also ask someone to witness your signature if you want.

You must be capable of making your own decisions when you make a living will. This means that you fully understand the document and its impact. For example, people suffering from advanced Alzheimer's often cannot create a living will because their ability to make decisions is severely affected.

 

What can I include in my living will?

It usually has two main parts. But as mentioned earlier, you have the final say about what to put in it.

First, you can say that you don't want medical personnel to give treatment that artificially prolongs your life.

It is a good idea to be specific about the treatments you don't want. Using vague terms can create confusion for medical staff and family and friends. For example, it can be a good idea to say that you don't want chemotherapy treatment, to be revived, to be maintained on life support, etc.

Another issue you can deal with in a living will is pain relief. You may want to say that you want your pain relieved even if this shortens your life or, on the contrary, that medical personnel should limit their palliative treatments.

 

When is a living will used?

Note that a living will is different from a will in which you say how you want your property dealt with after your death: a living will is used while you are alive, but not able to make your own decisions. The other kind of will is used after your death.

A living will only be used when you cannot express your wishes. This might be because of an illness, a coma or a total incapacity to express yourself verbally, physically or in writing.

Here is an example of a situation when a living will might be useful: Marcel must undergo surgery in a few days.  His doctor warns him that the operation involves significant risks and it is possible that he will remain in a coma afterwards.  Marcel decides to write a living will expressing his wishes for the end of his life, knowing that he might not be able to do so after the operation.

 

Can a living will be changed?

Yes. You can change or even destroy your living will at any time. Changes can be made in writing or verbally, but it is better to do them in writing. Also, make sure to inform your family, friends and medical staff of the changes.

In the same way that you must have all your mental abilities to make a living will, you must have them to change it too.

 

Do medical personnel have to respect a living will?

Any treating doctor must take into account a living will.

The doctor must check with you whether your living will still expresses your wishes, to the extent that this is possible. 

If you can't confirm your wishes to the doctor, she will check with your relatives to try to take a decision that respects what you would have wanted.

Even if you have a living will, a doctor must still exercise professional judgment. A doctor can't rely on your living will without first evaluating your situation and deciding what is appropriate treatment. In other words, the doctor will evaluate your medical condition and then consider your wishes as expressed in your living will.

 

Do friends and family have to respect a living will?

If someone has to make a decision on your behalf, a living becomes useful.  It is an excellent reference point for the people who will have to make difficult choices, while trying to respect your wishes.

But as is the case with medical staff, a living will does not free your family and friends from the duty to make treatment decisions based on the particular situation. For example, the person who makes decisions should not accept or refuse treatment based only on what your living will says. This person must use the living will to see what you would have decided given the circumstances.

 

Do I need to see a legal professional to make a living will?

No. You are free to write it yourself or with the help of someone you chose.

However, lawyers and notaries can give you advice on writing the document, and especially on how to make it very clear.

 

Do I have to give someone a copy of my living will?

No, but it is good idea to do this. If no one knows you have one, it might not be used.

If you don't give relatives or friends a copy, you can still tell someone where it is so they can find it quickly if necessary.

It can also be a good idea to put a copy of your living will in your medical record so medical personnel know your wishes.

Important !
This article explains in a general way the law that applies in Quebec. This article is not a legal opinion or legal advice. To find out the specific rules for your situation, consult a lawyer or notary.