The Living Will Declaration Form is an essential document in Canadian healthcare planning that addresses the growing need for clear advance medical directives. As medical technologies advance and healthcare decisions become more complex, individuals increasingly seek to maintain control over their future medical care. This document becomes particularly important when individuals are unable to communicate their healthcare preferences due to illness or incapacity. The form, which must comply with specific provincial legislation and healthcare regulations, typically includes detailed instructions about life-sustaining treatments, pain management, organ donation, and the appointment of substitute decision-makers. It serves as a vital tool for healthcare providers, family members, and legal representatives in understanding and implementing the declarant's healthcare wishes.
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1. Declaration and Personal Information: Identifies the declarant with full legal name, date of birth, address, and declaration of being of sound mind
2. Purpose of Declaration: States the purpose of the document as expressing wishes regarding future healthcare decisions
3. Definitions: Defines key terms used in the document such as 'life-sustaining treatment', 'terminal condition', 'healthcare provider', etc.
4. Appointment of Substitute Decision Maker: Designates primary and alternate healthcare proxy/substitute decision maker(s)
5. General Healthcare Directives: Broad statements about healthcare preferences and quality of life considerations
6. Specific Medical Treatments: Detailed preferences regarding specific medical treatments and procedures
7. Pain Management and Comfort Care: Preferences regarding pain relief and palliative care
8. Revocation Rights: Statement confirming the right to revoke or modify the declaration
9. Signature and Witnessing: Space for declarant's signature, date, and witness attestations
1. Organ and Tissue Donation: Instructions regarding organ and tissue donation wishes, to be included if the declarant wishes to address this
2. Religious or Cultural Preferences: Specific religious or cultural considerations affecting medical care, included when relevant to the declarant
3. Medical Assistance in Dying (MAID): Preferences regarding MAID, included if the declarant wishes to address this option
4. Pregnancy Provisions: Special instructions if the declarant is pregnant when the directive takes effect, included for women of childbearing age
5. Mental Health Treatment Preferences: Specific instructions regarding mental health treatment, included if the declarant has mental health concerns
6. Digital Health Records Access: Authorization for proxy access to digital health records, included if relevant to the jurisdiction
1. Schedule A - Medical Conditions: Detailed list of current medical conditions and relevant medical history
2. Schedule B - Medication List: Current medications and known drug allergies
3. Schedule C - Healthcare Provider Contact Information: List of current healthcare providers and their contact information
4. Appendix 1 - Substitute Decision Maker Acceptance: Formal acceptance by appointed substitute decision makers of their role and responsibilities
5. Appendix 2 - Family Contact Information: List of family members to be contacted in medical situations
6. Appendix 3 - Values Statement: Detailed statement of personal values and beliefs affecting medical decisions
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Patient Services
Risk Management
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Medical Records
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Relevant Roles
Healthcare Administrator
Medical Director
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Estate Planning Attorney
Healthcare Social Worker
Patient Care Coordinator
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Family Physician
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