Thank you for that question. I'm happy to address it through the chair.
I've heard a lot in the last hour about how to prepare people to sign advance requests, but in my view, and in the view of the medical literature on advance care planning, it is still not adequate consent, because you're lacking many elements of what you would need to know to consent to any kind of procedure.
In my experience, people sign all kinds of things without knowing exactly what they're signing. I've seen many of what we call in Quebec “protection mandates”, which are supposed to be just to name an alternative decision-maker. For some reason, they have started having end-of-life wishes inserted in them, which are so vague and general that they basically authorize any random doctor who meets you in the emergency room to decide that a treatment is superfluous given your condition.
It's very dangerous. When I ask the patients what they mean by it, they say it means that they don't want to be a vegetable. Essentially, it was not their wishes. It was a text that was given to them by somebody they trusted, and they signed it.
I would expect the same thing to happen regardless of all the safeguards that I've heard about in the last hour or so, because right now with the MAID regime in Canada, there are all kinds of people dying by MAID, horrifying the whole country. I can tell you even more stories from my own experience and from the experience of the people around me about how safeguards don't work and documents can be abused.
In my practice in geriatrics, I've seen documents abused all the time. I could tell you many stories, but I don't think I have more time to tell them right now.