Medical Aid in Dying

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The federal government is currently working on changing the Criminal Code to bring it into compliance with the judgment of September 11, 2019. The government obtained an extension until July 11, 2020 to do this. A second extension was granted until December 18, 2020 because of COVID-19. While awaiting this change at the federal level, the Criminal Code requirement of death being “reasonably foreseeable” continues to apply.

In Quebec, people who are suffering a lot can ask a doctor to give them medication to end their lives. 

This is called medical aid in dying (MAID). You might have heard it called medical assistance in dying, medically assisted dying, doctor-assisted death, medical help to die, or something similar. 

Given the irreversible nature of this procedure, the law is very strict about when it is allowed.

When It Can Be Given 

To get medical aid in dying, people must meet these requirements:

  • be 18 years old or older 
  • have a Quebec health insurance card
  • have the mental capacity to make their own decisions about their medical care
  • have a serious and incurable illness
  • have a medical condition that seriously affects their health, with no chance of getting better
  • be in constant and unbearable physical or psychological pain that can’t be relieved in a way the patient feels is tolerable (palliative care, sedation, etc.)

Important! A person cannot ask in advance for medical aid in dying. For example, if you have just been diagnosed with a degenerative disease, you can’t ask for medical aid in dying right after being diagnosed.

Asking for Medical Aid in Dying

The request must come from the patient and follow these steps:

  • Tell the doctor about the decision orally.
  • Ask a health care professional for the government form and fill it out.
  • Sign and date the form in front of a health care professional. The form must also be signed by this professional and two independent witnesses. This means the witnesses will not benefit in any way from the person’s death (for example, by inheritance) and are not part of the person’s medical team.
  • Repeat the wish to receive medical aid in dying at each new meeting with the doctor or other health care professional.

People who ask for medical aid in dying can change their minds. They can also ask for a postponement.

There must be at least 10 days between the time the request is made and the time medical aid in dying is given. In some situations, this period can be shortened.

Doctor’s Role 

A doctor asked to give medical aid in dying must check that all the requirements have been met. For example, the doctor must make sure that this is what the patient really wants and that no one pressured the patient. 

The doctor must meet with the patient several times to check whether the patient is still in unbearable pain and still wants medical aid in dying. 

The doctor must discuss the request with the medical team and, if the patient gives permission, with family members.

The doctor must also make sure the patient had a chance to discuss the decision with other people, if that’s what the patient wanted. 

The doctor must ensure the patient has all information necessary to make a decision. This includes information on the likely evolution of the patient’s illness and options for treatment.

Finally, the doctor responsible for the patient must get an opinion from another doctor. This second doctor must examine the patient, read the patient’s medical record, and confirm that all the legal requirements to get medical aid in dying have been respected.

Procedure

The doctor must personally give the medication causing the patient’s death.

The doctor must stay with the patient throughout the process, until the patient dies. The patient’s loved ones can be there, along with other people the patient wants present.

Important! Doctors can’t be forced to give medical aid in dying. For example, they can refuse if it is against their personal beliefs. In these situations, the institution must find a new doctor who will agree to look at the patient’s request.

After the patient dies, the doctor must send some forms:

  • a form to the Commission sur les soins de fin de vie (commission on end-of-life care) within 10 days of the death. One of the duties of this body is to make sure that medical aid in dying follows all the rules. 
  • a form to the Collège des médecins du Québec (association of doctors), or to the health care institution where the person who received medical aid in dying was being treated.

To learn more about medical aid in dying and the Act Respecting End-of-Life Care, see the Government of Quebec’s website.