Important Terms

Capacity – The ability to understand information that is relevant to making a personal care or medical decision and the ability to understand the consequences of a decision or lack of a decision.

Consent – To agree or give permission to a personal care or medical treatment decision.

Delegate – Someone who you authorize to make personal care or medical treatment decisions for you if you cannot make them yourself.

Informed consent means that you have received all information necessary to make your decision, including your medical diagnosis, available forms of treatment, and availale options to relieve suffering.

Personal directive – A legal document authorizing another person to make personal care or medical decisions for you.

Representative – A court may appoint a representative to make personal care or medical decisions for you if you cannot make them yourself and you have not appointed a delegate.

Who consents to medical treatment for me if I cannot?

Everyone in Nova Scotia has the right to make decisions for themselves about personal care and medical treatment as long as they have the capacity to do so. Capacity is the ability to understand information that you need to make a personal care or medical decision. It is also the ability to understand what can happen as a result of making a decision or not making a decision.

You can prepare for a time when you may not be able to make health care or personal care decisions for yourself by writing a personal directive while you are well. A personal directive is a legal document that names another person to make personal care or health care decisions for you. This person is called a delegate or a proxy. 

If you have not named someone to consent, or agree, to health care decisions, your doctor will ask your closest family member to consent for you. They will ask people in this order:

• spouse (including legally married spouses, registered domestic partner, or common-law partner),
• adult child,
• parent,
• grandparent,
• grandchild,
• aunt or uncle,
• niece or nephew, and then
• other relatives.

There is another way that someone could be named to make health care decisions for you when you cannot do it. A relative or friend can apply to the court to be named as your Representative. The courts might allow them to give consent to health care for you. Before naming a representative, a judge must establish that you are not able to consent and that the best thing for you is to have a representative. For more information, see the section on Adult Capacity and Decision-making.

In very unusual cases, there is no representative or other person who can consent for you. In these cases the Nova Scotia Public Trustee may be asked to give consent for you and might agree to take on this task. The Public Trustee is a government office that manages the affairs of some people who cannot do it for themselves.  For more information, see the Public Trustee’s website.

How do I name a delegate?

You must write a personal directive. In it, you may name any person to be your delegate who is at least 19 years old and mentally competent. If you want to name your spouse or partner and they are not yet 19 years old, you may do that. Mentally competent means the person must be able to make important decisions. The delegate does not have to be related to you.

Choose someone you can trust to carry out your wishes. Talk with your delegate about your wishes for your health care.

Your directive must be in writing, and you must sign it. A person who is not your delegate or their spouse must witness your signature. Name a back-up delegate in your directive. This is in case your first choice cannot act for any reason, even for a short time. For example, your delegate could be travelling in another country. In that case, your back-up delegate could make decisions for you. Your delegate could make decisions for you once they returned to the country or they could be reached.

Your personal directive could include instructions for your care, directions on who to consult about your care or who to notify about your circumstances, and how a delegate may be compensated for taking on this role.  The people giving you health care would need to respect those instructions if they could not reach your delegate or back-up delegate.

Do I need a lawyer to prepare a personal directive?

You don’t have to talk to a lawyer when you write your personal directive, but it is a good idea. Your lawyer can make sure that your directive meets all the legal requirements and says clearly what you want it to say.  Lawyers charge a fee based on the amount you want them to do.  The fee depends on how complex the work is.  You should discuss the fees with the lawyer before you decide to hire them. 

Talk with your regular health care provider — your doctor or nurse — when writing your directive. This will help you to decide what treatments you agree to. Your doctor can explain the different ways to treat your medical condition and can give the best instructions for your needs. Without medical advice, your instructions might not give the results you want.

What should I do if a hospital or care facility asks me to sign a standard personal directive form?

Some health care and residential care facilities use standard personal directives when patients or residents are admitted. These directives may include instructions that you would not want. For example, they might include a do-not-resuscitate order. 

You do not have to sign this standard form. Also, a hospital or health care facility in Nova Scotia cannot refuse to treat you or admit you just because you refuse to sign their directive. The Personal Directives Act says it is against the law for these facilities to demand a personal directive.

If you get a standard form, review it with your health care provider (your doctor or nurse)  before you decide whether to sign it. You might also show it to a lawyer. Do not sign a standard directive form if it would not give you the health care results you want. Instead, talk with your family about your health care wishes. You may want to write your own directive if you don’t already have one.

Many facilities will ask you if you have a personal directive. If you have one, give the facility a copy for its files.

How specific should my health care instructions be?

Your directive should be clear and detailed. Include the types of treatments you would agree to and those you would not agree to. Try to avoid broad statements that might reduce the options available for your treatment. For example, if you say you do not want to be given any medication, you might be ruling out a simple treatment that could ease your pain or help you overcome minor ailments during your illness.

Write down your values and beliefs in your personal directive as a way to assist in interpreting instructions and to help your delegate. 

Where should I keep my personal directive?

Give your doctor a copy of the directive to keep in your medical file. You could also give a copy to your delegate and to your close family members.

Keep the original at home in a special place. Tell your delegate or close family members where it is. Keep it in a firesafe box. 

Do not put your directive in a safe deposit box that is in your name only. If you do, your delegate may not be able to get to it. Although people who have been given copies of your directive may not need the original, your delegate should be able to get the original directive if needed.

For example, you could be in hospital and staff might not be able to find the copy you provided. A medical person who does not know you might need to see the original. Keep a list of people who have copies of your personal directive with the original. If you are travelling, take a copy of your directive with you. If you are going into hospital or a continuing care home, take a copy with you.  Some people like to put their delegate's contact information in the document.

How often should I update my personal directive?

Update your personal directive when you make important life changes, like a common law relationship, marriage, remarriage, or divorce. Update it if your delegate or back-up dies or becomes unable to consent.

Review your directive from time to time with your doctor. Medical treatments change regularly as research improves them. You might want to mention new treatment methods and technology. If you have a specific illness or condition, review your directive more frequently to make sure you keep up to date on treatments. 

Organizations that deal with diseases (like cancer, AIDS, or Alzheimer’s disease) have good information about new treatments and care. They can also give you support and help you and your family cope with the illness.

You can always ask your doctor or your medical specialist for more information, or you can go online. If you get information online, check to be sure that it comes from a reliable source.

How can I end a personal directive?

You can revoke, or end, your personal directive at any time, as long as you have capacity. You can declare your intention to cancel your personal directive in writing, and have it signed and witnessed. You can also destroy all copies of the old directive and write a new directive if you want to. 

Tell your doctor, hospital, or health care facility that you ended your personal directive. Get back any copies you gave them. They need to know that you have changed your mind, whether or not you make a new directive. You should also tell your family members.

You do not have to write a new directive to cancel the old one. If you decide to make a new directive, then include in it a paragraph that ends (revokes) the old directive. Give a copy of your new directive to your doctor. You could also give a copy to your delegate and to your family members.

Will my personal directive be valid outside Nova Scotia?

The are legal requirements for directives to be valid in Nova Scotia. The law about directives is not the same outside the province. If you are outside Nova Scotia and you cannot consent, your directive might not be followed. It would have to meet the requirements in the province or country you are visiting.

Before travelling, review your directive and get advice from your lawyer. That will help to make sure that your directive will be followed if you cannot consent to treatment while travelling. If you plan to live outside Nova Scotia for some time, you may want to write another directive that will be valid where you are living.

How are personal directives different from euthanasia and assisted suicide?

Euthanasia means an act one person takes to end the life of another to relieve their suffering. Assisted suicide is the act of intentionally killing oneself with the help of another person.

In Canada, certain eligible Canadian adults can ask for medical assistance in dying.  Medical assistance in dying provides patients who may be experiencing intolerable suffering due to a grievous and irremediable (incurable) medical condition the option to end their own life with the help of a physician (doctor) or nurse practitioner.  Medical assistance in dying is only provided to legally eligible persons.

You can write a personal directive that asks your delegate to refuse treatments that would make your life longer. But you cannot ask your delegate to take active steps to end your life.

Why can’t I consent to medical assistance in dying in my personal directive?

Canada allows two types of medical help for people who want to end their lives. If you meet the criteria for medical assistance in dying, a physician or nurse practitioner does one of the following:

• gives you a substance that causes death, such as injecting a drug, or

• gives you or prescribes a drug that you take yourself to cause your death.

In both of these methods, you must be able to give consent when the substance is given or taken. This is to make sure that your death is what you wish at that moment. It makes sure that no one else makes this important decision for you. It also makes sure that you gave full, informed consent when you were helped to die.

Informed consent means that you agree to medical treatment or to refuse medical treatment after you have all the information you need to make your decision. That information could include a description of your illness or problem, ways it could be treated, and ways to lessen suffering.

You might include advance consent to medical help in dying in your personal directive in case it becomes legal at a later date. If you do, you should speak with a lawyer about the type of wording to include in the directive.

What are the criteria for medical assistance in dying?

To be allowed to have medical help in dying, all of the following must be true:

• You are eligible for health services funded by the federal government, or a province or territory.
• You are at least 18 years old and mentally competent – able to make health care decisions for yourself.
• You have a serious illness, disease, or disability that is advanced and cannot be reversed.
• You have unbearable physical or mental suffering that cannot be relieved in ways you consider acceptable.
• You are at a point where your natural death is reasonably foreseeable, taking your medical circumstances into account.
• You are asking for medical assistance to die on your own without pressure or influence from another person.
• You can give informed consent to receive medical help in dying.

 You do not need to have a fatal or terminal condition and you do not need a specific prognosis about how long you have left to live.

How can I get medical assistance in dying?

You must ask in writing for this help. You must say you want to have a medically assisted death. Some provinces and territories may need you to complete a special form. Your health care provider might give you this form, or it might be on a provincial or territorial website.  You will find information for Nova Scotia on the Nova Scotia Health Authority website: nshealth.ca/about-us/medical-assistance-dying

If you cannot write, another adult can sign the request for you.

You must sign the written request before two independent witnesses, who must also sign it. Everyone must write the date on the request. An independent witness is one who:

• will not gain something from your death,
• does not own or run a health care facility where you live or receive care, and
• is not directly involved in giving you health or personal care.

Can I withdraw my request for medical help in dying?

Yes, you may choose to withdraw your request at any time. You do not have to go ahead with medical assistance in dying.

Where can I find more information?

Nova Scotia Department of Justice, Personal Directives, including sample forms and answers to common questions: www.novascotia.ca/just/pda/

Government of Canada website about medical assistance in dying: www.canada.ca/en/health-canada/services/medical-assistance-dying.html

End-of-life care in Nova Scotia: call 8-1-1 to speak to a registered nurse or go to www.811.novascotia.ca

Medical assistance in dying in Nova Scotia: call the Nova Scotia Health Authority at 902-491-5892 or visit www.nshealth.ca/about-us/medical-assistance-dying

Dying with Dignity Canada: www.dyingwithdignity.ca

Caregiving Benefits and Leave:  Contact Service Canada at 1-800-206-7218 for information about Employment Insurance Caregiver benefits to help you take time away from work to provide care or support to a critically ill or injured person or someone needing end-of-life care.

Nova Scotia Caregiving Benefits and Leave: contact Nova Scotia Labour Standards at 1-888-315-0110 for information about unpaid leaves from work under Nova Scotia's Labour Standards Code, including Critically Ill Adult and Child Care Leaves, Compassionate Care Leave.  

National Palliatve Care and other end-of-life resources