Health Care Directives Act

Manitoba Health
EMERGENCY TREATMENT GUIDELINES
APPENDIX
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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.
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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.
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EMERGENCY TREATMENT GUIDELINES
APPENDIX
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/ 1re 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:
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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/ 2e 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.
_________________________________________________
_________________________________________________
_________________________________________________
_________________________________________________
_________________________________________________
_________________________________________________
_________________________________________________
_________________________________________________
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APPENDIX
PART 3 – Signature and Date/3e 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 _____________________________________________________
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