[{"id":"0b4a191c-f7d5-47ae-aec6-85a3ab7cf4df","order":1,"text":"ADVANCE DIRECTIVE AND LIVING WILL","fontSize":"20","textAlign":"center","bold":true,"underline":false,"marginBottom":"30","cflou":false,"active":true},{"id":"2228c238-6892-4609-a51e-5685f8571fa6","order":2,"text":"I, [Full legal name of the Maker], of [Residential address — street number and name], [City or town], in the Province or Territory of [Province or territory of residence], born on [Date of birth], being of sound mind and acting of my own free will and without coercion, make this Advance Directive and Living Will (the "Directive") to set out my wishes and instructions concerning my health care and personal care, and to appoint a Substitute Decision-Maker to make decisions on my behalf should I become incapable of doing so myself.","fontSize":"14","textAlign":"left","bold":false,"underline":false,"marginBottom":"20","cflou":false,"active":true},{"id":"abf4bf23-2da0-4b0d-a22e-1110ac990f23","order":3,"text":"1. DEFINITIONS","fontSize":"16","textAlign":"left","bold":true,"underline":false,"marginBottom":"10","cflou":false,"active":true,"marginTop":"12","sectionNum":"S01"},{"id":"52f07ce3-90e4-4f4b-af5f-4c1f3eee462d","order":4,"text":"In this Directive, unless the context otherwise requires:","fontSize":"14","textAlign":"left","bold":false,"underline":false,"marginBottom":"6","cflou":false,"active":true},{"id":"44a1a7ad-e3df-443e-8231-699641b523d4","order":5,"text":""Advance Directive" means a written statement, made by a person while capable, that expresses the person's wishes or instructions respecting health care to be provided, or withheld, in circumstances that the person has specified, and that is intended to be used at a time when the person is incapable of making decisions about such health care.","fontSize":"14","textAlign":"left","bold":false,"underline":false,"marginBottom":"8","cflou":false,"active":true},{"id":"d1311622-ef9b-4a52-8e96-5f6c6eaa88e8","order":6,"text":""health care" means any examination, service, treatment, procedure or intervention that is performed for a health-related purpose and that is carried out by, or under the direction of, a physician, nurse or other regulated health professional.","fontSize":"14","textAlign":"left","bold":false,"underline":false,"marginBottom":"8","cflou":false,"active":true},{"id":"71aef3de-2198-4d6a-b40c-e56fabbe4e57","order":7,"text":""life-sustaining treatment" means any health care that, in the reasonable opinion of the attending physician, is necessary to sustain my life and without which I am likely to die within a relatively short period of time, including cardiopulmonary resuscitation, mechanical ventilation, dialysis, artificial hydration and nutrition, and the administration of blood products.","fontSize":"14","textAlign":"left","bold":false,"underline":false,"marginBottom":"8","cflou":false,"active":true},{"id":"4665a664-00bd-4f4a-879b-fe3687e82b88","order":8,"text":""Incapacity" means that I am unable to understand the information that is relevant to making a decision about my health care or personal care, or am unable to appreciate the reasonably foreseeable consequences of a decision or a lack of decision.","fontSize":"14","textAlign":"left","bold":false,"underline":false,"marginBottom":"8","cflou":false,"active":true},{"id":"10b1ba9c-20f9-4a8f-b4f0-0bd4d98fcc39","order":9,"text":""Substitute Decision-Maker" or "SDM" means the person appointed by me under this Directive to make decisions about my health care and personal care when I am incapable, and includes any alternate Substitute Decision-Maker so appointed.","fontSize":"14","textAlign":"left","bold":false,"underline":false,"marginBottom":"8","cflou":false,"active":true},{"id":"ec2241d4-e134-490c-b521-ebfc402d019a","order":10,"text":""attending physician" means the physician with primary responsibility for my care at the relevant time, and includes any other physician acting in that capacity.","fontSize":"14","textAlign":"left","bold":false,"underline":false,"marginBottom":"8","cflou":false,"active":true},{"id":"b47229a2-6c26-4e58-9278-40757e6977c4","order":11,"text":""personal care" means decisions respecting my shelter, nutrition, clothing, hygiene, safety, comfort and social activities, where such decisions do not concern health care as defined above.","fontSize":"14","textAlign":"left","bold":false,"underline":false,"marginBottom":"10","cflou":false,"active":true},{"id":"1034b40b-73b1-434f-8459-bc90a96eadfb","order":12,"text":"2. PURPOSE, SCOPE AND WHEN THIS DIRECTIVE TAKES EFFECT","fontSize":"16","textAlign":"left","bold":true,"underline":false,"marginBottom":"10","cflou":false,"active":true,"marginTop":"12","sectionNum":"S02"},{"id":"da3c348a-f2a3-44d8-84a0-87f9e861fb3e","order":13,"text":"This Directive is made in anticipation of Incapacity. It takes effect only at such time as my attending physician, or another qualified physician, has reasonably determined that I am incapable of making or communicating decisions about my health care or personal care.","fontSize":"14","textAlign":"left","bold":false,"underline":false,"marginBottom":"10","cflou":false,"active":true},{"id":"d8c5a930-9775-4736-b52f-bf6996d9c541","order":14,"text":"This Directive reflects my settled wishes and instructions and is intended to guide my Substitute Decision-Maker and my health care providers in making decisions consistent with my values and beliefs. It shall be interpreted and applied in a manner that respects my dignity, autonomy and the right to self-determination that I exercised by making it.","fontSize":"14","textAlign":"left","bold":false,"underline":false,"marginBottom":"10","cflou":false,"active":true},{"id":"890bf2d8-e4c0-49f6-9120-72c8ddad6050","order":15,"text":"Where any instruction in this Directive is inconsistent with a wish that I have expressed while capable, whether before or after the date of this Directive, my most recent capable expressed wish shall prevail. This Directive does not affect my right to make decisions about my own health care or personal care at any time when I remain capable of doing so.","fontSize":"14","textAlign":"left","bold":false,"underline":false,"marginBottom":"10","cflou":false,"active":true},{"id":"00c06177-d49f-4ae8-be3f-11c3d5ccec4d","order":16,"text":"3. APPOINTMENT OF SUBSTITUTE DECISION-MAKER","fontSize":"16","textAlign":"left","bold":true,"underline":false,"marginBottom":"10","cflou":false,"active":true,"marginTop":"12","sectionNum":"S03"},{"id":"e6cc47cc-48c3-4970-a925-9a8f5e3d3a02","order":17,"text":"I appoint the following person to act as my Substitute Decision-Maker for the purpose of making decisions about my health care and personal care when I am incapable of doing so myself:","fontSize":"14","textAlign":"left","bold":false,"underline":false,"marginBottom":"6","cflou":false,"active":true},{"id":"ffceb028-5a82-4212-bb42-2555882a5a99","order":18,"text":"Name: [Full name of the Substitute Decision-Maker]
Relationship to me: [Relationship of the Substitute Decision-Maker to the Maker]
Address: [Residential address of the Substitute Decision-Maker]
Telephone: [Telephone number of the Substitute Decision-Maker]","fontSize":"14","textAlign":"left","bold":false,"underline":false,"marginBottom":"10","cflou":false,"active":true},{"id":"b46c8d8b-2180-44c7-95f1-12dd4ba0966b","order":19,"text":"My Substitute Decision-Maker shall have authority to give or refuse consent to any health care proposed for me, to access my health care information, to select or change my health care providers and care facility, and to make any other decision concerning my health care or personal care that I could make if I were capable, subject always to the instructions and wishes set out in this Directive.","fontSize":"14","textAlign":"left","bold":false,"underline":false,"marginBottom":"10","cflou":false,"active":true},{"id":"6285bb9b-723f-4440-9765-7a8a0ee054a5","order":20,"text":"I have not appointed an alternate Substitute Decision-Maker. In the event that the Substitute Decision-Maker appointed above is unable, unwilling or unavailable to act on my behalf, I direct that the person authorized to make decisions on my behalf be determined in accordance with the statutory hierarchy set out in the Health Care Consent Act, where applicable, and the corresponding provincial legislation applicable in my province of residence.","fontSize":"14","textAlign":"left","bold":false,"underline":false,"marginBottom":"10","cflou":false,"active":true,"displayConditions":[{"field":"df1c53ca-0ddd-40a7-8f30-37e489c1c4f6","value":"0","type":"add","operator":"="}]},{"id":"1aa27ab4-7876-43b6-ba25-95c9ba41ff6b","order":21,"text":"4. ALTERNATE SUBSTITUTE DECISION-MAKER(S)","fontSize":"16","textAlign":"left","bold":true,"underline":false,"marginBottom":"10","cflou":false,"active":true,"marginTop":"12","sectionNum":"S04","displayConditions":[{"field":"df1c53ca-0ddd-40a7-8f30-37e489c1c4f6","value":"0","type":"remove","operator":"="}]},{"id":"ae36d234-db76-4fcd-9c60-e0fc7ae7d0ba","order":22,"text":"If the Substitute Decision-Maker appointed above is unable, unwilling or unavailable to act on my behalf, I appoint the following alternate(s), who shall have the same authority and duties as the Substitute Decision-Maker appointed above, in the order set out below:","fontSize":"14","textAlign":"left","bold":false,"underline":false,"marginBottom":"6","cflou":false,"active":true,"displayConditions":[{"field":"df1c53ca-0ddd-40a7-8f30-37e489c1c4f6","value":"0","type":"remove","operator":"="}]},{"id":"f3f41687-0096-41b9-9bbd-6e1836670cfd","order":23,"text":"— First alternate Substitute Decision-Maker:
Name: [Full name of the first alternate]
Relationship to me: [Relationship of the first alternate to the Maker]
Address: [Residential address of the first alternate]
Telephone: [Telephone number of the first alternate]","fontSize":"14","textAlign":"left","bold":false,"underline":false,"marginBottom":"8","cflou":false,"active":true,"displayConditions":[{"field":"df1c53ca-0ddd-40a7-8f30-37e489c1c4f6","value":"0","type":"remove","operator":"="}]},{"id":"fa945a67-c52e-4269-ac4c-793aa2c9c2ef","order":24,"text":"— Second alternate Substitute Decision-Maker:
Name: [Full name of the second alternate]
Relationship to me: [Relationship of the second alternate to the Maker]
Address: [Residential address of the second alternate]
Telephone: [Telephone number of the second alternate]","fontSize":"14","textAlign":"left","bold":false,"underline":false,"marginBottom":"10","cflou":false,"active":true,"displayConditions":[{"field":"df1c53ca-0ddd-40a7-8f30-37e489c1c4f6","value":"0","type":"remove","operator":"="},{"field":"df1c53ca-0ddd-40a7-8f30-37e489c1c4f6","value":"1","type":"remove","operator":"="}]},{"id":"a2e303e1-0601-4541-9dc6-2f2ba9215d40","order":25,"text":"5. GENERAL AUTHORITY AND DUTIES OF MY SUBSTITUTE DECISION-MAKER","fontSize":"16","textAlign":"left","bold":true,"underline":false,"marginBottom":"10","cflou":false,"active":true,"marginTop":"12","sectionNum":"S05"},{"id":"2011aa66-5e40-4173-b00a-cb46866f5c28","order":26,"text":"My Substitute Decision-Maker (and any alternate Substitute Decision-Maker appointed under this Directive) shall, when making any decision on my behalf:","fontSize":"14","textAlign":"left","bold":false,"underline":false,"marginBottom":"6","cflou":false,"active":true},{"id":"675b3559-d634-4395-aa7d-528e43d2061b","order":27,"text":"— make the decision in accordance with any specific instruction, wish or direction that I have expressed while capable and that is known to the Substitute Decision-Maker;","fontSize":"14","textAlign":"left","bold":false,"underline":false,"marginBottom":"6","cflou":false,"active":true},{"id":"cd4f5dc6-0efa-4b59-a8be-9a3d48bcc75a","order":28,"text":"— where no such wish or instruction is known, make the decision in accordance with my best interests, taking into account my values, beliefs and any prior expressions of preference, the likelihood of improvement or deterioration, the risks and benefits of the proposed health care, and my current condition; and","fontSize":"14","textAlign":"left","bold":false,"underline":false,"marginBottom":"6","cflou":false,"active":true},{"id":"4767c14a-7275-482a-9e8a-0d1e8df26f06","order":29,"text":"— consult, where reasonable, with persons close to me who may have insight into my wishes.","fontSize":"14","textAlign":"left","bold":false,"underline":false,"marginBottom":"10","cflou":false,"active":true},{"id":"22777218-85e5-4baf-a9de-951957a22732","order":30,"text":"I direct my health care providers to recognize the authority of my Substitute Decision-Maker and to rely on the instructions set out in this Directive when obtaining consent to health care for me.","fontSize":"14","textAlign":"left","bold":false,"underline":false,"marginBottom":"10","cflou":false,"active":true},{"id":"424d13d2-bb0c-44d8-b13d-d59acf22f855","order":31,"text":"6. STATEMENT OF MY VALUES AND HEALTH CARE WISHES","fontSize":"16","textAlign":"left","bold":true,"underline":false,"marginBottom":"10","cflou":false,"active":true,"marginTop":"12","sectionNum":"S06"},{"id":"99c973ff-63d1-4895-967f-419b63b8b125","order":32,"text":"The following statement reflects my values, beliefs and general wishes concerning my health care and personal care, and is intended to guide the interpretation of the specific instructions that follow:","fontSize":"14","textAlign":"left","bold":false,"underline":false,"marginBottom":"6","cflou":false,"active":true},{"id":"317ac980-b3b3-469e-bf15-a6237248b8b4","order":33,"text":"[Statement of the Maker's values and beliefs about care, if any]","fontSize":"14","textAlign":"left","bold":false,"underline":false,"marginBottom":"10","cflou":false,"active":true},{"id":"ff0a5730-46d2-476f-add9-416acde986f0","order":34,"text":"Where a specific instruction in this Directive is ambiguous or does not address the circumstances that have arisen, my Substitute Decision-Maker shall interpret the instruction in a manner consistent with this statement of values.","fontSize":"14","textAlign":"left","bold":false,"underline":false,"marginBottom":"10","cflou":false,"active":true},{"id":"fcb53630-d009-44bd-b76d-370735dbff08","order":35,"text":"7. CARDIOPULMONARY RESUSCITATION (CPR)","fontSize":"16","textAlign":"left","bold":true,"underline":false,"marginBottom":"10","cflou":false,"active":true,"marginTop":"12","sectionNum":"S07"},{"id":"a02e88bb-6c61-4269-80b6-1128705f7838","order":36,"text":"If I suffer cardiac or respiratory arrest, I consent to cardiopulmonary resuscitation (CPR) being attempted, including chest compressions, artificial ventilation, defibrillation and the administration of resuscitative medications.","fontSize":"14","textAlign":"left","bold":false,"underline":false,"marginBottom":"10","cflou":false,"active":true,"displayConditions":[{"field":"976795d3-0a4a-4a16-9e66-b1560fba48ec","value":"consent","type":"add","operator":"="}]},{"id":"db7d1461-8ac7-48a4-8ae8-35e445670b63","order":37,"text":"If I suffer cardiac or respiratory arrest, I do not consent to cardiopulmonary resuscitation (CPR) being attempted. I direct that a Do-Not-Resuscitate (DNR) order be entered on my medical record, and that I be allowed to die naturally with comfort care and pain relief as provided in this Directive.","fontSize":"14","textAlign":"left","bold":false,"underline":false,"marginBottom":"10","cflou":false,"active":true,"displayConditions":[{"field":"976795d3-0a4a-4a16-9e66-b1560fba48ec","value":"refuse","type":"add","operator":"="}]},{"id":"e856dab8-c9d6-456b-9b50-06e568276ece","order":38,"text":"8. LIFE-SUSTAINING TREATMENT AND END-OF-LIFE CARE","fontSize":"16","textAlign":"left","bold":true,"underline":false,"marginBottom":"10","cflou":false,"active":true,"marginTop":"12","sectionNum":"S08"},{"id":"566c2c99-6d5d-4385-b75e-15cbd6f265f8","order":39,"text":"I wish to receive all life-sustaining treatments that are medically indicated, for as long as they may prolong my life, even where there is no reasonable expectation of recovery, and I direct that such treatment be continued unless my attending physician determines that it is medically futile or would cause me disproportionate suffering. Any specific direction I have given in this Directive not to attempt cardiopulmonary resuscitation, or to withhold or withdraw artificial hydration and nutrition, shall prevail over this general instruction to the extent of any inconsistency.","fontSize":"14","textAlign":"left","bold":false,"underline":false,"marginBottom":"10","cflou":false,"active":true,"displayConditions":[{"field":"624add38-1d0a-46fe-b374-aa42379bdd27","value":"all","type":"add","operator":"="}]},{"id":"fec1c4ca-db6b-4da6-9884-ef7a5680a922","order":40,"text":"I wish to receive life-sustaining treatment only if my attending physician reasonably believes that the treatment will restore me to a state in which I can recognize others, express myself and care for myself. If life-sustaining treatment would serve only to prolong the process of my dying without restoring such capacity, I direct that it be withheld or withdrawn and that I be allowed to die naturally. Any specific direction I have given in this Directive not to attempt cardiopulmonary resuscitation, or to withhold or withdraw artificial hydration and nutrition, shall prevail over this general instruction to the extent of any inconsistency.","fontSize":"14","textAlign":"left","bold":false,"underline":false,"marginBottom":"10","cflou":false,"active":true,"displayConditions":[{"field":"624add38-1d0a-46fe-b374-aa42379bdd27","value":"limited","type":"add","operator":"="}]},{"id":"cd23efc9-6888-48f8-aff4-5929a9170c92","order":41,"text":"I do not wish to receive life-sustaining treatment if I am in an advanced state of irreversible decline, a permanent coma, a persistent vegetative state, or any other condition in which my attending physician reasonably believes that I will not recover the ability to recognize others, to express myself, or to care for myself. In any such circumstance, I direct that life-sustaining treatment be withheld or withdrawn and that I be allowed to die naturally with dignity. Any specific direction I have given in this Directive not to attempt cardiopulmonary resuscitation, or to withhold or withdraw artificial hydration and nutrition, shall prevail over this general instruction to the extent of any inconsistency.","fontSize":"14","textAlign":"left","bold":false,"underline":false,"marginBottom":"10","cflou":false,"active":true,"displayConditions":[{"field":"624add38-1d0a-46fe-b374-aa42379bdd27","value":"none","type":"add","operator":"="}]},{"id":"c8ac8548-6e8b-425e-a16b-58120f2cbe38","order":42,"text":"9. ARTIFICIAL HYDRATION AND NUTRITION","fontSize":"16","textAlign":"left","bold":true,"underline":false,"marginBottom":"10","cflou":false,"active":true,"marginTop":"12","sectionNum":"S09"},{"id":"60e01df5-2ec4-4d85-90af-4ec77e72d56b","order":43,"text":"If I am unable to take food and fluids by mouth, I consent to the provision of artificial hydration and nutrition, including by intravenous line or feeding tube, subject to my instructions concerning life-sustaining treatment set out in this Directive.","fontSize":"14","textAlign":"left","bold":false,"underline":false,"marginBottom":"10","cflou":false,"active":true,"displayConditions":[{"field":"2195971e-f26a-4c35-9154-fb0cdac354b9","value":"accept","type":"add","operator":"="}]},{"id":"6d05d908-adc5-40d6-ab5c-8fd673fed5dd","order":44,"text":"If I am in an irreversible condition or permanently unconscious, I refuse artificial hydration and nutrition and direct that it be withheld or withdrawn. I understand that this may hasten my death, and I confirm that this reflects my settled wish.","fontSize":"14","textAlign":"left","bold":false,"underline":false,"marginBottom":"10","cflou":false,"active":true,"displayConditions":[{"field":"2195971e-f26a-4c35-9154-fb0cdac354b9","value":"refuse","type":"add","operator":"="}]},{"id":"af3ff20f-e8a2-4ca4-a4ad-2455298baf54","order":45,"text":"I consent to a trial of artificial hydration and nutrition if my attending physician believes it may help me recover, but I direct that it be withdrawn if it becomes clear that I will not recover the ability to take food and fluids by mouth.","fontSize":"14","textAlign":"left","bold":false,"underline":false,"marginBottom":"10","cflou":false,"active":true,"displayConditions":[{"field":"2195971e-f26a-4c35-9154-fb0cdac354b9","value":"temporary","type":"add","operator":"="}]},{"id":"056f96fd-b0e2-4d1d-8cdb-05e9d71d1317","order":46,"text":"10. PAIN RELIEF AND COMFORT CARE","fontSize":"16","textAlign":"left","bold":true,"underline":false,"marginBottom":"10","cflou":false,"active":true,"marginTop":"12","sectionNum":"S10"},{"id":"88b7b70e-93e2-4edf-858c-ccc2d8194011","order":47,"text":"I direct that I receive [Pain relief preference of the Maker]. I wish to be kept as free from pain and discomfort as reasonably possible, and I authorize my attending physician and Substitute Decision-Maker to ensure that appropriate palliative and comfort care is provided to me, including measures to relieve pain, breathlessness, nausea, anxiety and agitation.","fontSize":"14","textAlign":"left","bold":false,"underline":false,"marginBottom":"10","cflou":false,"active":true},{"id":"f3e96e80-cb71-4cab-b53b-ee03dda036a4","order":48,"text":"11. ORGAN AND TISSUE DONATION","fontSize":"16","textAlign":"left","bold":true,"underline":false,"marginBottom":"10","cflou":false,"active":true,"marginTop":"12","sectionNum":"S11"},{"id":"5b7d5ec8-799e-49bc-b85e-3c8fd44a083f","order":49,"text":"Regarding organ and tissue donation, I direct that, upon my death, [Organ and tissue donation preference of the Maker].","fontSize":"14","textAlign":"left","bold":false,"underline":false,"marginBottom":"10","cflou":false,"active":true},{"id":"736f528d-8505-45bf-8502-6df6acbea499","order":50,"text":"[Additional wishes regarding organ and tissue donation, if any]","fontSize":"14","textAlign":"left","bold":false,"underline":false,"marginBottom":"10","cflou":false,"active":true},{"id":"5483ea1e-238d-473a-ab4c-65131bc76ac7","order":51,"text":"Where any part of my body is donated in accordance with this Directive, I authorize my Substitute Decision-Maker and my health care providers to take all steps reasonably necessary to give effect to that donation, including the maintenance of my body on life support for such period as may be required to preserve the viability of the organs and tissues to be donated, where this is consistent with the other instructions set out in this Directive.","fontSize":"14","textAlign":"left","bold":false,"underline":false,"marginBottom":"10","cflou":false,"active":true,"displayConditions":[{"field":"338a2ac2-7a63-4172-a1f2-a9c7be16f6c9","value":"no organs or tissues be donated","type":"remove","operator":"="}]},{"id":"53edd4e3-b99d-46d1-80c4-95313a32a4c4","order":52,"text":"12. PERSONAL CARE DIRECTIONS","fontSize":"16","textAlign":"left","bold":true,"underline":false,"marginBottom":"10","cflou":false,"active":true,"marginTop":"12","sectionNum":"S12"},{"id":"22223553-aeeb-4dd4-8ad3-aefc34979bdf","order":53,"text":"If I become incapable of making decisions about my personal care, I direct my Substitute Decision-Maker to take the following into account:","fontSize":"14","textAlign":"left","bold":false,"underline":false,"marginBottom":"6","cflou":false,"active":true},{"id":"8d86b4e0-70bc-4c07-badb-ae8dde4d985e","order":54,"text":"[Personal care preferences of the Maker, if any]","fontSize":"14","textAlign":"left","bold":false,"underline":false,"marginBottom":"10","cflou":false,"active":true},{"id":"b5dd507e-8d21-4759-a041-8ef51d950307","order":55,"text":"Regarding my final arrangements after death, I express the following wishes:","fontSize":"14","textAlign":"left","bold":false,"underline":false,"marginBottom":"6","cflou":false,"active":true},{"id":"69f2161f-4abb-47cb-b056-0a11cc0a0880","order":56,"text":"[Funeral, burial or cremation wishes of the Maker, if any]","fontSize":"14","textAlign":"left","bold":false,"underline":false,"marginBottom":"10","cflou":false,"active":true},{"id":"2c97083a-f9a9-4fbd-aad5-34073b6f2ecd","order":57,"text":"13. REVIEW, AMENDMENT AND REVOCATION","fontSize":"16","textAlign":"left","bold":true,"underline":false,"marginBottom":"10","cflou":false,"active":true,"marginTop":"12","sectionNum":"S13"},{"id":"3f950239-29b0-48d0-ab9d-9da00a59b164","order":58,"text":"I may review, amend or revoke this Directive at any time while I remain capable of doing so. I may revoke this Directive, in whole or in part, by any of the following means:","fontSize":"14","textAlign":"left","bold":false,"underline":false,"marginBottom":"6","cflou":false,"active":true},{"id":"3ec2875e-7d91-4117-8df5-8b7537f43f9e","order":59,"text":"— by making a written statement, dated and signed by me, expressing my intention to revoke;","fontSize":"14","textAlign":"left","bold":false,"underline":false,"marginBottom":"6","cflou":false,"active":true},{"id":"13439f67-e623-40c7-a886-87f20faed283","order":60,"text":"— by deliberately destroying this Directive with the intention of revoking it;","fontSize":"14","textAlign":"left","bold":false,"underline":false,"marginBottom":"6","cflou":false,"active":true},{"id":"3754f297-74ae-4ae8-a3de-9af9ce1cee6f","order":61,"text":"— by making a new advance directive or appointment that is inconsistent with this Directive, in which case the more recent document shall prevail to the extent of the inconsistency; or","fontSize":"14","textAlign":"left","bold":false,"underline":false,"marginBottom":"6","cflou":false,"active":true},{"id":"3ed81c30-2728-4475-977c-1d4b776b1583","order":62,"text":"— by orally expressing my intention to revoke, in the presence of a witness, where the law of my province of residence recognizes oral revocation.","fontSize":"14","textAlign":"left","bold":false,"underline":false,"marginBottom":"10","cflou":false,"active":true},{"id":"ebbbce2f-9756-48f1-9cb5-9fa42c0375b2","order":63,"text":"Any amendment to this Directive shall be made in writing, dated and signed by me in the presence of the witnesses required by the law of my province of residence. A revocation does not revive any prior directive that I had previously revoked.","fontSize":"14","textAlign":"left","bold":false,"underline":false,"marginBottom":"10","cflou":false,"active":true},{"id":"b3ab5e26-3d7c-4264-84d2-1bf4eef558b9","order":64,"text":"14. INTERACTION WITH OTHER DOCUMENTS AND STATUTORY RECOGNITION","fontSize":"16","textAlign":"left","bold":true,"underline":false,"marginBottom":"10","cflou":false,"active":true,"marginTop":"12","sectionNum":"S14"},{"id":"f7ca69d9-799e-47b5-aea2-d4c3694a5b78","order":65,"text":"This Directive is intended to operate alongside, and not to revoke, any power of attorney for personal care or equivalent instrument that I have validly executed, except to the extent of any direct inconsistency, in which case the document that is more recent in date shall prevail to the extent of the inconsistency. If I have not executed a separate power of attorney for personal care, the appointment of my Substitute Decision-Maker under this Directive shall be given effect in accordance with the Health Care Consent Act and the corresponding provincial legislation applicable in my province of residence.","fontSize":"14","textAlign":"left","bold":false,"underline":false,"marginBottom":"10","cflou":false,"active":true},{"id":"ea91bdc3-fcc2-4716-baf2-a577201abe87","order":66,"text":"This Directive is made in reliance on the recognition given to advance directives, living wills and appointments of substitute decision-makers by the common law and by the legislation of the Canadian provinces and territories, including the Health Care Consent Act. I request that this Directive be recognized and given effect in any province or territory in which I may be located at the relevant time, to the fullest extent permitted by the law of that province or territory.","fontSize":"14","textAlign":"left","bold":false,"underline":false,"marginBottom":"10","cflou":false,"active":true},{"id":"79afd8fd-a0df-4487-91ea-be8abb2cf286","order":67,"text":"15. GOVERNING LAW AND JURISDICTION","fontSize":"16","textAlign":"left","bold":true,"underline":false,"marginBottom":"10","cflou":false,"active":true,"marginTop":"12","sectionNum":"S15"},{"id":"0e111f0b-5be3-4133-86bc-ce91d382570a","order":68,"text":"This Directive is governed by the laws of the Province or Territory of [Province or territory of residence] and the federal laws of Canada applicable therein, including, where applicable, the Health Care Consent Act and the corresponding provincial legislation governing advance directives and substitute decision-making. Any question concerning the interpretation or validity of this Directive shall be determined in accordance with the law of that province or territory.","fontSize":"14","textAlign":"left","bold":false,"underline":false,"marginBottom":"10","cflou":false,"active":true},{"id":"04a21dd0-8a6b-4eff-b601-793d34dc8a14","order":69,"text":"16. GENERAL PROVISIONS","fontSize":"16","textAlign":"left","bold":true,"underline":false,"marginBottom":"10","cflou":false,"active":true,"marginTop":"12","sectionNum":"S16"},{"id":"a65df8b0-1424-40da-a4d4-e3a04f3bf334","order":70,"text":"— Severability. If any provision of this Directive is held to be invalid, illegal or unenforceable, that provision shall be severed and the remaining provisions shall continue in full force and effect to the greatest extent permitted by law.","fontSize":"14","textAlign":"left","bold":false,"underline":false,"marginBottom":"8","cflou":false,"active":true},{"id":"2938a9c8-b765-47df-aecb-a0cf8a945db3","order":71,"text":"— Entire Directive. This Directive, together with any document expressly referred to in it, constitutes the entire expression of my wishes and instructions concerning the matters addressed in it and supersedes all prior inconsistent directions, except as provided in the section of this Directive entitled "Interaction with Other Documents and Statutory Recognition".","fontSize":"14","textAlign":"left","bold":false,"underline":false,"marginBottom":"8","cflou":false,"active":true},{"id":"eede6d33-e386-4ecb-a551-a62023d5fe1b","order":72,"text":"— Headings. The headings used in this Directive are for convenience of reference only and shall not affect its interpretation.","fontSize":"14","textAlign":"left","bold":false,"underline":false,"marginBottom":"8","cflou":false,"active":true},{"id":"6d40c082-fae6-4796-8d79-1c2467f665d8","order":73,"text":"— Copies. A signed copy or photocopy of this Directive shall be as valid and effective as the original.","fontSize":"14","textAlign":"left","bold":false,"underline":false,"marginBottom":"8","cflou":false,"active":true},{"id":"f737129b-c7c9-4350-a157-a74ce1817c99","order":74,"text":"— No Expiry. This Directive remains in force until it is revoked by me in accordance with the section of this Directive entitled "Review, Amendment and Revocation".","fontSize":"14","textAlign":"left","bold":false,"underline":false,"marginBottom":"10","cflou":false,"active":true},{"id":"039f9fda-ade7-4faa-a3d7-34258e1f95a8","order":75,"text":"17. DECLARATION, SIGNATURE AND WITNESSES","fontSize":"16","textAlign":"left","bold":true,"underline":false,"marginBottom":"10","cflou":false,"active":true,"marginTop":"12","sectionNum":"S17"},{"id":"4e917801-9f37-4c40-a5ab-16dd7b68ee76","order":76,"text":"I declare that I have read and understood this Directive, that I am making it voluntarily and free from coercion, and that I am capable of making decisions about my health care and personal care.","fontSize":"14","textAlign":"left","bold":false,"underline":false,"marginBottom":"10","cflou":false,"active":true},{"id":"a3c53103-c0b0-4212-80b7-ba5256d02d79","order":77,"text":"Signed by the Maker, [Full legal name of the Maker], at [City and province of signing], on [Date of signing].","fontSize":"14","textAlign":"left","bold":false,"underline":false,"marginBottom":"6","cflou":false,"active":true},{"id":"10326b2b-cb1a-4088-a1d9-6e0f8693b0f4","order":78,"text":"_______________________________________
Signature of the Maker","fontSize":"14","textAlign":"left","bold":false,"underline":false,"marginBottom":"20","cflou":false,"active":true,"marginTop":"10"},{"id":"9377c25b-887a-441e-93af-367950a294c8","order":79,"text":"The Maker signed this Directive in our presence, and we, in the Maker's presence and in the presence of each other, have signed as witnesses. We each declare that we are at least eighteen (18) years of age, and that we are not the Maker's spouse, partner, child, parent or sibling, not the Substitute Decision-Maker or any alternate Substitute Decision-Maker appointed under this Directive, and not the spouse or partner of any such person, to the extent required by the law of the Maker's province of residence.","fontSize":"14","textAlign":"left","bold":false,"underline":false,"marginBottom":"10","cflou":false,"active":true},{"id":"9365fbce-2cbd-4be1-b230-43be2faf11c5","order":80,"text":"Witness 1:
Name: [Full name of the first witness]
Address: [Address of the first witness]
_______________________________________
Signature of Witness 1","fontSize":"14","textAlign":"left","bold":false,"underline":false,"marginBottom":"20","cflou":false,"active":true,"marginTop":"10"},{"id":"5f83d75c-322b-4308-ac33-04a01180a14c","order":81,"text":"Witness 2:
Name: [Full name of the second witness]
Address: [Address of the second witness]
_______________________________________
Signature of Witness 2","fontSize":"14","textAlign":"left","bold":false,"underline":false,"marginBottom":"10","cflou":false,"active":true,"marginTop":"10"}]