Almost non-existent impact of advance medical directives: Quebec Commission on end-of-life care recommends re-evaluating the regime

Since their introduction in 2016, advance medical directives (AMDs) have enabled any person of full age and capacity to indicate in advance whether they consent to or refuse certain medical care in the event of incapacity. They apply only to end-of-life situations, severe and irreversible cognitive impairment and severe dementia with no possibility of improvement. 

In the report about end-of-life care in Quebec 2018-2023, tabled on February 18, 2025, in the Quebec National Assembly, the Commission recommends that the relevance of the current AMDs regime be reconsidered.

According to statistics provided in the report, since 2016, only 1.9% of Quebec adults have registered their AMDs in the register managed by the Régie de l'assurance maladie du Québec. The Commission highlights several obstacles to the adoption of AMDs, including:

- A lack of awareness among the public and healthcare professionals;

- A process perceived as complex, requiring administrative steps and sometimes notarial fees;

- Limited scope of application;

- Complex procedures for healthcare professionals to access the registry or obtain access via the Dossier Santé Québec (DSQ).

The Commission believes that to simplify the process, it would be appropriate to allow DMAs to be completed online after secure authentication, or to allow an anonymous form to be downloaded, filled in and submitted. An alternative would be to require the countersignature of a healthcare professional on a generic form, possibly excluding notaries from the process. This approach would also allow citizens to discuss the various options with a healthcare professional during a consultation before finalizing their decision. However, a very similar process has already existed for many years, namely goal of care discussions and determination. 

It's high time Quebecers stopped being lied to and to abandon the regime of advance medical directives in favor of real, lasting implementation of goal of care discussions and, above all, measures to increase people's knowledge of end-of-life issues, and the appointment of one or more surrogate decision makers to whom they have transmitted their values and preferences during informed discussions.