How to Update or Revoke an Advance Directive in Quebec

You Can Change Your Mind Anytime

Quebec's advance medical directives (DMA) are not permanent. As long as you have mental capacity, you can revoke your existing directives, change your treatment decisions, or replace the entire document with a new one. The law treats your most recent capable expression as the definitive version of your wishes.

This matters because medical circumstances change. A diagnosis of a chronic condition might shift your perspective on certain treatments. Advancing age, new medical technologies, or changes in your family situation can all make you reconsider decisions you made years earlier.

How to Revoke Your DMA

There are two formal revocation paths:

Complete the RAMQ revocation form. RAMQ provides a specific form — the Révocation des directives médicales anticipées — for cancelling your existing directives. Sign it and mail it directly to RAMQ. Once processed, your directives are removed from the provincial registry and your medical team will no longer see them when they access your electronic file.

Execute a new DMA. If you want to change your treatment decisions rather than simply cancel them, you don't need to revoke first. Complete a new barcoded DMA form through ClicSÉQUR, sign it with two qualified witnesses, and submit it to RAMQ. The newly registered document automatically revokes and replaces the older version in the database.

If your original DMA was drafted as a notarized act, you can execute a new notarized directive that automatically cancels the previous registration.

What You Cannot Do

You cannot make handwritten edits to an existing form. Crossing out a treatment decision, changing "accept" to "refuse" with a pen, or adding margin notes does not legally modify your registered directives. RAMQ's registry reflects the original submission. To change anything, you must execute an entirely new document following the full formal process — new form, new signatures, new witnesses, new submission.

You cannot partially revoke. The RAMQ revocation form cancels the entire DMA, not individual treatment decisions. If you want to change one decision while keeping the other fourteen, submit a complete new DMA with all your current decisions.

Emergency Verbal Override

If you're facing a medical situation where your registered DMA doesn't reflect what you want — and you're still mentally capable at that moment — your immediate verbal instructions override your registered directives.

A capable person's contemporaneous decision always takes precedence over a previously documented one. If your DMA says "refuse CPR" but you tell the emergency physician "I want CPR," the physician follows your verbal instruction. This principle applies even if you're disoriented or medically fragile, as long as you're assessed as having capacity to consent at that specific moment.

Once you're no longer capable of giving consent, the registered DMA resumes control.

When You Should Review Your DMA

Consider reviewing your directives when:

• You receive a new medical diagnosis — especially one that might affect the clinical scenarios in your DMA (terminal illness, cognitive decline, or conditions that could lead to coma)
• Your family circumstances change — a divorce, the death of your mandatary, or estrangement from the person you assumed would advocate for you
• You change your mandatary — if you've executed a new protection mandate with a different representative, verify that your DMA witnesses aren't disqualified by the new mandate
• Medical advances change the picture — a treatment you refused five years ago may have improved significantly, or new end-of-life options may have become available
• You move to or from Quebec — if you move to another province, your RAMQ registration doesn't transfer. If you move to Quebec from elsewhere, your out-of-province advance directive may not be recognized. Either way, you need a fresh document in your new jurisdiction.

Updating Your Protection Mandate at the Same Time

If you're revising your DMA, check whether your protection mandate also needs attention. The two documents interact:

• A new mandatary in your protection mandate may disqualify one of your DMA witnesses
• A change in your health status may make the scope of authority in your mandate too narrow (e.g., you may now need "complete administration" powers for real estate transactions)
• If your mandatary has died or become incapacitated themselves, your protection mandate may be inoperative even though your DMA is still registered

Keeping both documents current means your advance care plan functions as a coherent whole rather than a collection of documents that may contradict each other.

For worksheets to track your document versions, witness eligibility, and review schedule, the Quebec Advance Directive Kit includes a document revision tracker alongside the DMA treatment worksheet and protection mandate builder.

See more Quebec guides →