In Quebec, people who are suffering unbearably can ask a doctor to give them medication to end their lives. This procedure is called medical aid in dying (MAID). You may have also heard it called “medical help to die” or something similar. Given the irreversible nature of this procedure, the law is very strict about when it is allowed. Here are the general conditions under which it is permitted, the process for requesting it and the measures in place to protect the patient. Some additional rules may apply depending on whether the patient’s death from natural causes is reasonably foreseeable, or not.
General conditions for obtaining medical aid in dying
To obtain medical aid in dying in Quebec, people must meet all the following 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
- have been informed about any available means to relieve suffering
- have decided that those means are intolerable
From the moment of their initial request, the patient must be capable of understanding and consenting to medical aid in dying, free of any outside pressure.
These conditions apply to all patients who wish to obtain medical aid in dying, whether or not their natural death is reasonably foreseeable. Therefore, a person who does not meet the above conditions cannot ask for medical aid in dying in Advance Medical Directives, for example.
Requesting medical aid in dying
A patient who wishes to obtain medical aid in dying must use a government form to request it. They must sign and date the form. A healthcare professional must be present as an independent witness when the patient signs the form. This professional must give the form to the patient’s doctor.
The doctor then evaluates the request based on the above-mentioned general requirements. If the doctor is satisfied that the patient meets these requirements, a second doctor, who is not involved in treating the patient, must also confirm in writing that the patient meets the requirements and is eligible for medical aid in dying.
Important! A doctor who receives a request for medical aid in dying is not obliged to administer it. A doctor can refuse if medical aid in dying is against their personal values, for example. In this situation, the director of the healthcare establishment must find a doctor who is willing to consider the request.
Measures to protect the patient
Before providing medical aid in dying, the doctor must ensure that a several measures to protect the patient have been respected. The doctor must ensure that:
- The patient has had an opportunity to discuss the request with their loved ones and, if the patient wishes, that their loved ones were able to discuss the request with the doctor.
- If the patient has difficulty communicating, they were provided with a reliable means of communication, and it has been verified that the patient understands the information they received.
- The patient repeated the request for medical aid in dying at different moments with some time having passed between the requests if the length of the illness permits.
- The patient consents to receive medical aid in dying immediately before it is administered. The patient can change their mind right up to the very last moment.
Once all these protection measures have been complied with, the rest of the process depends on whether the death by natural causes is reasonably foreseeable. “Reasonably foreseeable” does not refer to a specific time period. The patient does not need a prognosis for how long they are expected to live.
If the patient’s natural death is reasonably foreseeable
If the patient’s natural death is reasonably foreseeable, and all the above-mentioned general conditions and protection measures have been respected, the doctor can administer medical aid in dying without further delay. The patient’s loved ones, or anyone else they would like to have present, can be at the patient’s side during their final moments.
The doctor must again ensure that the patient clearly consents to receive medical aid in dying before administering it.
In some situations, a patient whose natural death is reasonably foreseeable may lose their ability to express consent before medical aid in dying is administered.
It is, therefore, possible for a patient to consent to have medical aid in dying administered on a specific date. The date is set out in a written agreement and must be within 90 days of the signature of the agreement. If the patient does, indeed, lose the ability to express their consent, the requirement to express consent just before medical aid in dying is administered does not apply.
However, the doctor will not administer medical aid in dying if the patient demonstrates a refusal or reluctance to receive it. This could be based on the patient’s words, sounds or gestures.
Important! This exception applies only to patients whose natural death is reasonably foreseeable. Other patients must clearly express their consent to medical aid in dying just before it is administered.
If natural death is not reasonably foreseeable
If the patient’s natural death is not reasonably foreseeable, in addition to the above-mentioned general conditions and protection measures being met, the doctor must:
- Consult a doctor who is a specialist in the patient’s medical condition if the doctor is not themself a specialist in this domain.
- Discuss with the patient other means for relieving their suffering, such as counselling services, mental health and disability support services, community services and palliative care, and ensure that the patient has seriously considered them.
- Wait 90 days from the beginning of the patient’s initial evaluation of their eligibility for medical aid in dying. The doctor can only administer medical aid in dying once the 90 days are up, unless there is a serious risk that the patient will lose their capacity to consent to medical aid in dying.
Once these additional conditions have been met, the doctor can administer medical aid in dying to the patient.