News & Updates | August 29, 2025 | Dying With Dignity Canada
Advance Care Planning. Advance Directives. Advance requests. What’s the difference? While it’s easy to get confused by these terms, understanding the nuances is key to making sure that your wishes for care are communicated properly.
In this post, you’ll find a helpful overview of the concepts our supporters ask us about most often. While some of the vocabulary may sound similar, each term is different and has important legal, ethical, and practical implications for end-of-life planning.
Case Study: Bob
Bob, 80, has coronary artery disease. Medication controls his symptoms, but he can no longer hike or fish, instead enjoying art classes and Senior Centre activities.
Determined to avoid isolation or losing independence, he completes Dying With Dignity Canada’s Advance Care Planning Kit and Advance Directive, and shares it with his daughter.
After a heart attack leaves him incapacitated, doctors tell his daughter that he will likely not regain capacity or brain function, and will not be able to live independently or participate in his hobbies. Faced with the choice of aggressive treatment or comfort care, she reviews his Advance Care Plan and chooses to end life support after three days without any improvement. Bob dies peacefully, surrounded by family.
Advance Care Planning (ACP) is a generic term for the process of thinking about and expressing your wishes for future health care and treatment.
Your Advance Care Plan, the documents where you record your wishes, is used if you are in a state where you are not competent to make health care decisions for yourself (e.g. you are unconscious, experiencing cognitive impairment, etc.).
Advance Care Planning is not one document or decision, but an umbrella term for a set of practices and tools that may include Advance Directives and other formal or informal expressions of care preferences. Importantly, Advance Care Planning does not cover medical assistance in dying (MAID), as requests for MAID in advance are not currently legal across Canada. They can, however, be used to demonstrate that your preferences regarding MAID are consistent over time. For that reason, some people choose to include their support for MAID and the situations they may want MAID in the future in their Advance Care Planning documents.
Interested in Advance Care Planning? Download our ACP Kit here.
An Advance Directive is a document, written while you are well and able to make decisions, in which you state your wishes for future medical or non-medical care. It is intended to ensure that your end-of-life wishes are respected in the event that you become unable to make decisions for yourself. The name of the document might be different depending on the province or territory in which you live.
Read more here about making your Advance Directive useful, usable, and effective.
Case Study: Jaime
Five years after a breast cancer diagnosis, Jaime learns further treatment would only prolong their life by months and chooses quality time with family instead.
Jaime has always known they may one day consider medical assistance in dying (MAID). After a thorough assessment by two independent nurse practitioners (NPs), they are approved for MAID and opt to drink the oral medication rather than have MAID administered through IV. Jaime understands that the oral medication option can take longer.
Consent is normally needed before each medical intervention during MAID. Because Jaime will quickly become incapacitated after drinking the oral medication, they have the option to provide advance consent. This would allow the NP present at their bedside to legally provide them with MAID via IV should the medication take too long. Together, they decide on a 30 minute limit.
On the day of MAID, Jaime takes the oral medication and becomes comatose. They look peaceful and comfortable, but still have a pulse after 30 minutes. The NP administers MAID via IV, as planned. Jaime dies peacefully with family holding their hands.
If you are eligible for medical assistance in dying (MAID) and choose to self-administer the medications orally, you can provide advance consent — a written arrangement with your provider to complete your assisted death via intravenous (IV), if needed. This enables you to create a back-up plan in the event that you take the oral MAID medications but do not die within a pre-specified time period. By giving advance consent in this situation, your nurse practitioner or physician can legally complete the MAID administration process for you via IV, despite you not being able to consent at that moment. This type of Advance Consent is less common in the Canadian context, where self-administration is rarely chosen.
Case Study: Dana
Dana has terminal cancer that has spread to her brain. She chooses to start the process for MAID. On July 1, after two assessments, Dana is approved for MAID and selects October 1 as her chosen death date. Despite suffering severely, she wants to try to meet her first grandchild before she dies but also recognizes that she is at high risk of capacity loss. Her doctor explains that she is eligible to sign a waiver of final consent in case she loses capacity before October 1.
Dana would like her best friend, Audrey, to be with her during MAID. Conditions like this can be added to the waiver, but they are binding, so flexibility is encouraged. Dana requests her best friend Audrey be present “if possible.”
The baby arrives early, and Dana enjoys several visits. In late September, she loses consciousness and cannot open her eyes, speak or communicate in any way. Her doctor confirms she has lost capacity. Dana’s family contacts Audrey and she arrives in time. On September 29, with safeguards complete and family gathered, Dana receives MAID and dies peacefully.
If you have already been assessed and approved for MAID, a waiver of final consent is a document that allows you to receive it on or before your chosen date, even if you do not have the capacity to consent at the time of the MAID procedure.
If you are at risk of losing your ability to give consent to receive MAID, completing a waiver allows you to waive the requirement to give your express consent right before the MAID drugs are administered.
The waiver of final consent can only be used under specific conditions:
Although the purpose of a waiver is to allow for MAID in the event of capacity loss, the process will not go forward if you (even while incapacitated) show any signs of resistance or refusal through words, sounds or gestures when MAID is to be administered.
It is also important to note that any specifications included in your waiver must be met for you to receive MAID. If you include, for example, that a specific family member must be present, then that requirement must also be met for MAID to occur.
Read more here about waivers of final consent and the landmark case that helped make them legal in Canada.
An advance request would allow a person who may not yet meet the criteria for MAID to make a written request for MAID that could be honoured later, after they lose the capacity to make medical decisions for themselves. Currently advocacy is focused on advance requests that would allow an individual already diagnosed with a capacity-eroding condition to describe, in writing, a future circumstance in which they would like to access an assisted death. Then if, at some point, they lost the capacity to make medical decisions for themself, met all the relevant criteria — and, importantly, reached a point where their suffering became unbearable — this formal request could be honoured. Advance requests for MAID are not currently legal at a federal level in Canada. They are available under certain conditions in Quebec. For those in Quebec, you can find more information here.
If you’re part of the 84% of people across Canada who support advance requests for individuals with a grievous and irremediable medical condition, learn more and get involved with our advocacy here.
Each of these terms represents a different legal or clinical approach to planning for future care. The distinctions between them are especially significant in situations involving serious illness, incapacity, or decisions about MAID.
Understanding and using the correct terminology can help ensure that your wishes are known, respected, and legally protected. When planning for the future, it’s important to consult health care providers, legal professionals, and trusted individuals to develop a comprehensive plan based on your personal values and wishes.
If you have any questions about your end-of-life planning, Dying With Dignity Canada’s Support team can be reached at support@dyingwithdignity.ca.
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