In Quebec, people who are experiencing unbearable suffering can ask a doctor to give them medication to end their lives. This procedure is called medical aid in dying (MAID). You might also hear it referred to as “medical help to die” or something similar. The law strictly regulates who can request medical aid in dying and under what conditions it can be provided.
|
Requesting medical aid in dying in advance: When is it allowed? This article only covers requests to receive medical aid in dying in the near future (sometimes called “contemporaneous requests for medical aid in dying”). But in some situations, people can request medical aid in dying well in advance, in case they become incapacitated later. Since October 30, 2024, people who have been diagnosed with a serious and incurable disease leading them to incapacity can make “advance requests for medical aid in dying”. This allows them to consent to receiving medical aid in dying in the future, when they are no longer able to consent to care. For example, someone in the early stages of Alzheimer’s may choose this option. |
General conditions for obtaining medical aid in dying
To obtain medical aid in dying in Quebec, people must meet all the following requirements:
- have a Quebec health insurance card,
- be 18 years old or older,
- have the mental capacity to make their own decisions about their medical care,
- be in one of these situations:
- and be in a state where their abilities are severely and permanently getting worse, with no chance of improvement,
- have a serious physical impairment that greatly affects their abilities for an extended period,
- be in constant and unbearable physical or psychological pain,
- be informed about any available means to relieve suffering,
- have decided that those means are intolerable.
|
Can someone request medical aid in dying because of a mental disorder? Neurocognitive disorders are the only mental disorders recognized as serious and incurable illnesses that qualify for medical aid in dying. For example, a person with Alzheimer’s disease may receive medical aid in dying if they meet all the other requirements. This means that as of now, people with severe and chronic depression cannot request medical aid in dying. |
How to request medical aid in dying
A patient who wishes to obtain medical aid in dying can request it by using a government form. They must sign and date the form. The request must be made freely, without any outside pressure, and with all the information necessary to make an informed decision.
A healthcare professional must be present and sign the form afterwards. In some cases, an independent witness must also sign the form.
If the patient is unable to sign the form, someone else can sign it for them in their presence and following their instructions.
What happens after the initial request?
A healthcare professional who is authorized to administer medical aid in dying will evaluate the request. Only doctors and specialized nurse practitioners (SNPs) can administer medical aid in dying.
Once a doctor or SNP assesses the request, they must ask a second doctor or SNP to confirm in writing that the patient is eligible to receive medical aid in dying.
|
Important! A doctor or SNP who receives a request for medical aid in dying is not obliged to administer it. They can refuse if medical aid in dying goes against their personal values, for example. In this situation, the director of the healthcare establishment must find a another professional who is willing to consider the request. |
The doctor or SNP must also ensure that several measures to protect the patient have been respected. They must ensure that:
- The patient made their request freely and with all the information necessary to make an informed decision.
- The patient repeated their request at different moments.
- The patient has had an opportunity to discuss the request with their loved ones.
- The patient has the opportunity to change their mind right up to the very last moment.
If the patient has trouble communicating, the doctor or SNP must also ensure that the patient was given a reliable means of communication and understands the information they had received.
The rest of the process depends on whether the patient’s death by natural causes is considered “reasonably foreseeable”. The law doesn’t specify a time frame for when natural death becomes “reasonably foreseeable”.
If the patient’s 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 or SNP must:
- Get a third opinion from a specialist in the patient’s medical condition, if neither them nor the second professional is a specialist in this area.
- 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.
- Obtain the patient’s consent to receiving medical aid in dying immediately before it is administered.
- Wait at least 90 days from the beginning of the initial evaluation of the patient’s eligibility for medical aid in dying. The doctor or SNP can only administer medical aid in dying once the 90 days are up. The only situation where they can proceed without waiting 90 days is when there is a serious risk that the patient will lose their capacity to consent to medical aid in dying.
If the patient’s natural death is reasonably foreseeable
If the patient’s natural death is reasonably foreseeable, the doctor or SNP can administer medical aid in dying without further delay.
The doctor or SNP must however ensure that the patient clearly consents to receive medical aid in dying right before administering it.
In some situations, a patient can receive medical aid in dying without needing to confirm their consent immediately before the procedure. This can happen when their natural death is reasonably foreseeable, and they may lose their ability to express consent before medical aid in dying is administered. In this case, the patient can confirm in a written document that they consent to receiving medical aid in dying on a specific date. The date they choose must be within 90 days of the signature of the document. Even if they indeed lose their ability to express their consent afterwards, a doctor or SNP can administer medical aid in dying anyway.
However, the doctor or SNP will not administer medical aid in dying if the patient demonstrates a refusal or reluctance to receive it on the spot.
Important! This exception applies only to patients whose natural death is reasonably foreseeable. Patients whose natural death is not reasonably foreseeable must always clearly express their consent to medical aid in dying just before it is administered.
Where can the patient receive medical aid in dying?
The patient can receive medical aid in dying in one of the following places:
- a healthcare facility (like a hospital, a local community service centre or a long-term care centre),
- a palliative care hospice,
- at home,
- somewhere else (only with special authorization).
In any case, nobody is allowed to ask them to pay for services directly or indirectly related to the procedure, like the rental of a place to receive it.