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authors: Tamayo-Velázquez MI, Simón-Lorda P, Goodridge D, Steeves M. last update: 02/09/2010
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Canada is a country occupying most of northern North America, extending from the Atlantic Ocean in the east to the Pacific Ocean in the west and northward into the Arctic Ocean. It is the world's second largest country by total area. Canada's common border with the United States to the south and northwest is the longest in the world.
A federation consisting of ten provinces and three territories, Canada is governed as a parliamentary democracy and a constitutional monarchy with Queen Elizabeth II as its head of state. It is a bilingual nation with both English and French as official languages at the federal level.
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Currently, there is no national uniformity of Advance Directives in Canada. Depending on the province, there are different laws regulating Advance Directives.
- The age for making advance directives has not been defined uniformly in all the states: 16 years old in Ontario or Manitoba, 18 in Alberta, 19 in Northwest Territories or "every competent person" in Newfoundland and Labrador.
- Also changes the age range that the proxy or witnesses must have.
- The number of required witnesses varies by state.
- Some states have legal forms for AD but they are not required.
- Generally AD must be writed, signed and witnessed. British Columbia allows verbal AD.
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In Canada there is no federal law on advance health care planning. There is different legislation depending on the province. The following provinces have advance directives legislation:
- Alberta
- British Columbia
- Manitoba
- Newfoundland
- Northwest Territories
- Nova Scotia
- Ontario
- Prince Edward Island
- Quebec
- Saskatchewan
- Yukon Territory
New Brunswick and Nunavut do not have advance directives legislation. The following are the legal terms used to describe advance directives in Canadian jurisdictions:
- Advance Directive: Yukon (proxy directive)
- Advance Health Care Directive: Newfoundland and Labrador; Prince Edward Island (instructional and proxy)
- Authorization: Nova Scotia (proxy directive)
- Health Care Directive: Manitoba and Saskatchewan (instructional and proxy)
- Mandate: Quebec (proxy directive)
- Personal Directive: Alberta and Northwest Territories (instructional and proxy)
- Power of Attorney for Personal Care: New Brunswick and Ontario (proxy directive)Representation Agreement: British Columbia (proxy directive).
The following are the legal terms used to describe a proxy in Canadian jurisdictions:
- Agent: Alberta and Northwest Territories
- Attorney for Personal Care: New Brunswick and Ontario
- Guardian: Nova Scotia
- Mandatary: Quebec
- Proxy: Prince Edward Island; Manitoba; Saskatchewan; Yukon
- Representative: British Columbia
- Substitute Decision Maker: Newfoundland and Labrador.
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In Canada there is no national registry of Advance Directives. Some of the provinces provide their own AD registry system.
There is no record tracking the number of ADs completed by citizens in Canada.
Living Wills Registry. www.livingwills.com. This non official registry was established by Dr David Williams, a Stratford family physician, and his wife Maureen in 1992. The Registry's mandate is to assist people in directing their own medical treatment in the event of incapacitating illnesses or injuries.
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Required form
Some states have legal forms for AD but they are not mandatory.
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What is an Advance Directive?
An advanced directive is a legal document prepared and signed by a person in advance of a severe illness or injury, which will guide health care providers when providing health care and treatment. It may give instructions -- i.e., state what treatment or care someone wants to receive or not receive if he or she becomes unable to make medical decisions (for example, because he/she is unconscious or in a coma). A health care directive is also used to plan in advance for situations where a person is no longer mentally capable of making her or his own health care decisions.
Some advance directives will identify a person (a proxy) who would be responsible for making treatment decisions on behalf of the person if she or he becomes mentally incapable.
There are several different types of advance directives in Canada. Each province uses slightly different language, and very importantly, each has different laws for making and relying on these powerful documents.
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More information about Advance Directive$sin Canadacan be found via the following organizations:
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Research projects
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Publications Books
- Molloy, W. Let me decide. Whywe all need a living will. Penguin Canada. 23 Dec 2005. ISBN 9780143055495.
- Guo, Bing; Harstall, Christa.Advance directives for end-of-life care in the elderly: effectiveness ofdelivery modes. Edmonton, Alta. : Alberta Heritage Foundation for MedicalResearch, 2004. ISBN: 1896956939.
Articles
- GarrettDD, Tuokko H, Stajduhar KI, Lindsay J, Buehler S. Planning for End-of-LifeCare: Findings from the Canadian Study of Health and Aging. Can J Aging. 2008Spring;27(1):11-21.
- Mengual RP,Feldman MJ, Jones GR. Implementation of a novelprehospital advance directive protocol in southeastern Ontario. CJEM.2007 Jul;9(4):250-9
- Molloy DW, Guyatt GH, Russo R,Goeree R, O'Brien BJ, Bédard M, Willan A, Watson J, Patterson C, Harrison C,Standish T, Strang D, Darzins PJ, Smith S, Dubois S. Systematic implementationof an advance directive program in nursing homes: a randomized controlledtrial. JAMA.2000 Mar 15;283(11):1437-44.
- Molloy DW, Guyatt GH, Russo R,Goeree R, O'Brien BJ, Bédard M, Willan A, Watson J, Patterson C, Harrison C,Standish T, Strang D, Darzins PJ, Smith S, Dubois S. Systematic implementationof an advance directive program in nursing homes: a randomized controlledtrial. JAMA.2000 Mar 15;283(11):1437-44
- Blondeau D, Valois P,Keyserlingk EW, Hébert M, Lavoie M.Comparison of patients' and health careprofessionals' attitudes towards advance directives. JMed Ethics. 1998 Oct;24(5):328-35
- Patterson C, Molloy DW, GuyattGH, Bedard M, North J, Hassard J, Willison K, Jubelius R, Darzins P. Systematicimplementation of an advance health care directive in the community. CanJ Nurs Adm. 1997 May-Jun;10(2):96-108.
Links
Other resources
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