26 février 2020

Les directives médicales anticipées (DMA) consistent en un écrit par lequel une personne majeure et apte à exprimer sa volonté indique à l’avance les soins médicaux qu’elle accepte ou refuse de recevoir dans le cas où elle deviendrait inapte à consentir à des soins dans trois situations cliniques précises. C’est ce que certains nommaient auparavant « testament biologique ».

Voici les trois situations cliniques prévues par la loi :

  • situation de fin de vie dans un contexte de maladie grave et incurable ;
  • situation d’atteinte grave et irréversible des fonctions cognitives, dans un contexte d’état comateux jugé irréversible, ou d’état végétatif permanent ;
  • autre situation d’atteinte grave et irréversible des fonctions cognitives, sans possibilité d’amélioration, par exemple une démence de type Alzheimer ou un autre type de démence de stade avancé.

Selon la loi du Québec, les DMA ont une valeur contraignante, c’est-à-dire que le personnel de la santé est obligé de les suivre, car elles sont l’équivalent des volontés exprimées par une personne apte à consentir à des soins. Les professionnels de la santé qui y ont accès n’ont pas à obtenir l’autorisation du représentant du patient (la personne qui peut consentir à des soins pour elle) ni de ses proches et doivent appliquer les DMA conformément aux volontés que vous avez exprimées.

Il n’existe que deux manières reconnues par la loi de consigner des DMA. La première consiste à obtenir un formulaire auprès du gouvernement, à le remplir et à le signer devant deux témoins majeurs. Il n’y a aucune obligation de faire notarier vos DMA. La seconde manière est l’acte notarié, à signer auprès d’un notaire.

Pour obtenir votre formulaire personnalisé, vous pouvez le demander en ligne :

  • Tapez dans votre moteur de recherche : Directives médicales anticipées
  • Pour obtenir le formulaire électroniquement via le site Internet de la RAMQ, la personne doit avoir un compte clicSÉQUR. Autrement, elle peut commander le formulaire par téléphone.
    • Québec : 418 646-4636
    • Montréal : 514 864-3411
    • Ailleurs au Québec : 1 800 561-9749

Avant de demander votre formulaire à la RAMQ, il est fortement recommandé de bien vous informer au sujet des DMA en consultant la section des directives médicales anticipées du site de la RAMQ et du site officiel du gouvernement du Québec.

Il est important de savoir que les DMA peuvent être révoquées ou modifiées en tout temps par leur signataire en signant un nouveau formulaire ou un nouvel acte notarié à cet effet.

L’enregistrement au « Registre des DMA de la RAMQ » est essentiel pour garantir que le personnel médical a accès aux DMA. L’AQDMD vous suggère fortement de donner une copie de vos DMA à votre médecin de famille et/ou être déposée dans tout dossier médical. De plus, nous vous suggérons aussi fortement d’en donner une copie à un membre de votre famille ou une personne de confiance.

Il est essentiel de comprendre que les DMA ne peuvent pas être incluses dans un testament ou dans un mandat de protection (anciennement appelé mandat en prévision de l’inaptitude ou en cas d’inaptitude) : ce sont des documents différents.

Il est primordial de ne pas confondre les DMA et l’aide médicale à mourir (AMM). À l’heure actuelle, il n’est pas encore possible de demander l’AMM dans vos DMA, mais cela pourrait changer dans les mois qui viennent. Le 11 septembre 2019, la Cour supérieure du Québec a conclu (Truchon c. Procureur général du Canada) qu’il était inconstitutionnel de limiter l’accès à l’AMM aux personnes en fin de vie. La décision du tribunal devait initialement entrer en vigueur le 11 mars 2020, toutefois, la Cour supérieure du Québec a accordé au gouvernement fédéral quatre mois supplémentaires pour faire adopter son projet de loi. Bien qu’elle ne s’applique qu’au Québec, le gouvernement du Canada s’est engagé à modifier la loi sur l’AMM pour l’ensemble du pays. Afin de se conformer à cette décision, les gouvernements provincial et fédéral ont lancé des consultations qui porteront sur l’accès à l’aide médicale à mourir et sur l’élargissement des directives médiales anticipées (DMA).

Vous trouverez des renseignements supplémentaires sur le site de l’AQDMD : https://aqdmd.org/

Dr Georges L’Espérance, neurochirurgien, et président de l’Association québécoise pour le droit de mourir dans la dignité

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