by Anthony Schratz
This is a sample legal document for use in the province of Ontario, Canada only. Readers are cautioned to review this document with their legal advisor before signing it.
Made in accordance with the Substitute Decisions Act, 1992
1. I, Susan Smith, residing and domiciled at 30 Avenue Road, Toronto, Ontario, born on September 30, 1945, Social Insurance number 495 626 987, revoke any previous power of attorney for property and power of attorney for personal care made by me and appoint my husband, John Smith to be my attorney for property and for personal care in accordance with the Substitute Decisions Act, 1992, under the terms and conditions set out in this power of attorney.
2. In the event that my attorney be unable or unwilling to act through resignation, refusal, illness, death or removal, I nominate and appoint __________________ as my attorney in his place and stead.
3. Considering that life on earth is a gift and a blessing from God, I believe that it is not the absolute and supreme value. Knowing that death is inevitable and will terminate my earthly existence, by Faith I nevertheless believe that death opens up for me a way to life with God which is everlasting. Consequently, in the event of my becoming unable to take care of myself or to administer my property as a result of an accident, illness, old age or any other cause, my Attorney shall have the following powers:
a) With respect to my property, I authorize my attorney to do on my behalf anything that I could do if capable of managing property, except make a will, subject to the law and to any conditions or restrictions contained in this document. I confirm that he may do so only if I am incapable.
b) With respect to my personal care, I give my attorney the authority to make any personal care decision for me which I am incapable of making for myself, including the giving or refusing of consent to any matter to which the Health Care Consent Act, 1996 applies, subject to the Substitute Decisions Act, 1992, and to the instructions, conditions and restrictions contained in this power of attorney.
c) My attorney is to ensure my spiritual, moral and material well being, and notably to accomplish any act aimed at fulfilling my needs, considering my standard of living and the value of my patrimony; and to help me face my own death in a Christian way, and to prepare myself for this final event of my earthly existence in peace, in the company of those whom I love and in the consolation of the Catholic Faith. My attorney shall enjoy sole, complete and unrestricted discretion with respect to the way of applying this paragraph.
d) My attorney is to make all decisions with respect to the care and treatment necessitated by my state of health, where such care or treatment is considered by my attorney in his absolute discretion appropriate in the circumstances, but always on the condition that such decisions are in keeping with and fully respect the moral standards and teaching of the Roman Catholic Church. I authorize my Attorney in his absolute discretion to refuse my being kept alive by extraordinary artificial means. My Attorney may also, in his absolute discretion, require that I receive any medication that can alleviate my suffering. I declare that I am completely opposed to euthanasia, and that, notwithstanding any other disposition contained in this document, under no circumstances is anything contained in this power of attorney to be interpreted as authorizing any person to practice euthanasia on me.
e) It is understood that in the exercise of his functions my Attorney is authorized to consult my medical and social records as well as any other records concerning my person and property.
f) I hereby authorize my Attorney in his entire discretion to give his consent or not to the donation of any or all of my organs upon my death for purposes of transplant or for other medical purposes. He is to make this decision in conscience taking into account whatever particular circumstances may obtain at the time of my death. In all cases, this authorization is conditional on the following: before any organs are removed from my body, a doctor named by my Attorney must verify and personally certify in writing that I have died, failing which no organs are to be removed (or some other option).
4. It is my intention that this document is both a continuing power of attorney for property and a personal care power of attorney pursuant to the Substitute Decisions Act, 1992 and may be used notwithstanding my incapacity to manage property.
IN WITNESS WHEREOF I HAVE SIGNED AT TORONTO THIS
We, the undersigned, Janet Harford and Alice MacDougall, both witnesses to the signature of Susan Smith to the present deed, hereby declare that we have no interest whatsoever in the said deed and that at the moment of her signature she enjoyed full capacity to act. In witness whereof, we have signed at Toronto on _________2003 with and in the presence of Susan Smith and each other.
A F F I D A V I T
I, the undersigned, Alice MacDougall, receptionist, residing and domiciled at 30 Park Road, Toronto, Ontario, being duly sworn do depose and say:
1. That I am one of the two subscribing witnesses to the signature of the foregoing Mandate by Susan Smith as well as by the second witness, Jane Hartford;
2. I know the said Susan Smith as well as the second witness, Janet Hartford, and we are all three of us of the age of majority;
3. The signatures of Susan Smith, Janet Harford and the undersigned appearing on the foregoing Mandate are really those of the signatory and the witnesses of the said Mandate.
AND I HAVE SIGNED
Sworn to before me at
Toronto, this ____________
Anthony Schratz, LLB
The Catholic Legate
October 28, 2003