A Canadian Advance Directive, also known as a Personal Directive, Health Care Directive, or Living Will depending on the province, is a legal document that allows a competent adult to express their preferences regarding future healthcare and personal care decisions in the event they become mentally incapable of communicating those decisions themselves. The document serves two primary functions: it provides written instructions about the types of medical treatment and personal care the Maker wishes to receive or refuse, and it appoints a Substitute Decision-Maker (SDM) to carry out those wishes and make decisions on matters not specifically addressed in the directive.

Advance directive legislation in Canada is a provincial and territorial matter, resulting in different terminology and requirements across jurisdictions. In Ontario, healthcare decision-making authority is governed by two complementary statutes: the Health Care Consent Act, 1996 (S.O. 1996, c. 2, Sched. A), which establishes the framework for consent to treatment and the hierarchy of substitute decision-makers, and the Substitute Decisions Act, 1992 (S.O. 1992, c. 30), which governs Powers of Attorney for Personal Care. In Alberta, the Personal Directives Act (RSA 2000, c. P-6) allows individuals to create a single document that both appoints an agent and provides treatment instructions. British Columbia uses the Representation Agreement Act (RSBC 1996, c. 405) to authorize the appointment of a representative for healthcare decisions, while the Health Care (Consent) and Care Facility (Admission) Act (RSBC 1996, c. 181) governs consent to treatment.

In Quebec, the Civil Code of Quebec (arts. 11-25) governs consent to care, and a mandate given in anticipation of incapacity (mandat de protection) under arts. 2166-2174 serves a similar function to an advance directive in common law provinces. The mandate must be notarized or witnessed by two witnesses and must be homologated (validated) by the court before the mandatary can act. Across all provinces, the fundamental principle is that a capable person has the right to consent to or refuse any medical treatment, and an advance directive extends that right to future situations where the person may lack capacity.

Every Canadian adult should consider creating an advance directive as part of their overall estate and personal planning. An advance directive is particularly important when you are diagnosed with a serious or progressive illness such as cancer, dementia, ALS, or Parkinson’s disease, and want to ensure that your healthcare wishes are documented before you may lose the capacity to express them. Without an advance directive, decisions about your care will be made according to the statutory hierarchy of substitute decision-makers established by your province’s legislation, which may not reflect your actual preferences.

You should create an advance directive if you hold strong views about specific medical interventions such as cardiopulmonary resuscitation, mechanical ventilation, artificial nutrition and hydration, or dialysis. The document allows you to accept or refuse each intervention individually, providing clear guidance to your healthcare team. This is especially important for older adults, individuals undergoing major surgery, or anyone with a chronic condition that could lead to incapacity.

An advance directive is also essential if you wish to express your views on Medical Assistance in Dying (MAiD), which is available in Canada under the Criminal Code (s. 241.2, as amended by Bill C-7). While an advance directive alone cannot currently authorize MAiD in most provinces, it can inform your SDM of your wishes should you later meet the eligibility criteria. An advance directive should be updated after major life events such as marriage, divorce, the birth of a child, a significant health diagnosis, or relocation to a different province, since each province has its own formal requirements for validity.

A valid Canadian Advance Directive must include clear identification of the Maker with full legal name, address, date of birth, and a declaration that the Maker is of sound mind and understands the nature of the document. The directive must specify the governing province, as each jurisdiction has different formal requirements: Ontario requires two witnesses for a Power of Attorney for Personal Care (Substitute Decisions Act, s. 10), Alberta requires one witness for a Personal Directive (Personal Directives Act, s. 5), and BC requires two witnesses for a Representation Agreement (s. 13 of the Act).

The appointment of a Substitute Decision-Maker must include the SDM’s full name, contact information, and relationship to the Maker, along with a clear statement of whether the SDM has full authority or limited authority. Appointing an alternate SDM is strongly recommended. The directive should specify the SDM’s obligations: to follow the Maker’s expressed wishes where applicable, and where the directive is silent, to act in the Maker’s best interests, considering the Maker’s known values and beliefs.

Treatment instructions should address life-sustaining measures, including CPR, mechanical ventilation, artificial nutrition and hydration, and dialysis. Palliative care preferences should specify the desired level of pain management and the preferred location for end-of-life care. The directive should address organ and tissue donation wishes in accordance with provincial Human Tissue Gift Act legislation. A revocation clause should state that all prior directives are revoked and that the Maker retains the right to revoke this directive at any time while capable. Finally, the directive must comply with the witnessing requirements of the governing province, and copies should be distributed to the SDM, the Maker’s family physician, and any relevant healthcare institutions.