In Quebec, people can ask to receive medical aid in dying in the near future if they meet certain conditions. But did you know that since October 30, 2024, it’s possible for some people to request medical aid in dying well in advance? “Advance requests for medical aid in dying” are only available to people who have been diagnosed with a serious and incurable disease leading them to incapacity. When a person makes an advance request, their intention is to receive medical aid in dying when they become unable to consent to care and are in constant and unbearable pain. These people are not looking to receive medical aid in dying in the short term.
Requests to receive medical aid in dying in the near future are sometimes called “contemporaneous requests for medical aid in dying”. Contemporaneous requests follow different rules than the ones outlined in this article.
Who can make an advance request for medical aid in dying?
To make an advance request for medical aid in dying, a person must:
- have been diagnosed with a serious and incurable illness that will lead to incapacity to give consent to health care, like Alzheimer’s disease,
- be able to consent to health care when making the request,
- be 18 years old or older,
- have a Quebec health insurance card (RAMQ).
Someone who makes an advance request for medical aid in dying doesn’t need to be enduring constant and unbearable pain at the time of the request. This is only a condition to request receiving medical aid in dying in the short termmedical aid in dying in the near future.
Advance requests for medical aid in dying vs. advance medical directives: two different concepts
Advance requests for medical aid in dying and advance medical directives both allow people to request or deny medical treatment for when they will no longer be able to consent to care.
But each is used for a completely different purpose:
- People who make advance medical directives decide ahead of time whether they want to receive specific health care treatments to prolong their life.
- On the other hand, people who make an advance request for medical aid in dying decide ahead of time to receive medication that will end their life.
Since they serve different purposes, advance medical directives and advance requests for medical aid in dying cannot be included in the same document.
How to make an advance request for medical aid in dying
A person who wants to make an advance request for medical aid in dying must personally make the request. They must be assisted by a doctor or a specialized nurse practitioner (SNP) to fill out the form. Doctors and SNPs are the only professionals allowed to help patients with this process.
In the form, the person making the request, and the doctor or SNP assisting them, must describe the symptoms to come that justify administering medical aid in dying. It’s important to note that the person won’t receive medical aid in dying as soon as these symptoms appear. Other conditions must also be met.
The doctor or SNP must also make sure that the person is making the request
- after having received all necessary information about their illness, its expected progression, and the possible treatments,
- without any outside pressure,
- after having had the chance to discuss their decision with their loved ones, if they wish.
The person can make the request in front of a notary or in front of two witnesses. In both cases, the person and the medical professional assisting them must both sign the form. The completed request is then added to an official register that contains all advance requests for medical aid in dying.
It’s always possible to cancel an advance request for medical aid in dying.
What happens once the person becomes incapacitated?
When the person becomes incapacitated, their request is monitored in two ways: through trusted third parties and the register of advance requests for medical aid in dying.
These two mechanisms help inform or remind medical and social services staff that the person had made an advance request for medical aid in dying.
Trusted third parties
A person making an advance request for medical aid in dying can name one or two trusted third parties. One of their responsibilities is to make sure that the medical or social services staff caring for the person are aware of the request.
The register of advance requests for medical aid in dying
Doctors and SNPs must check the register of advance requests for medical aid in dying each time they find that a patient with a serious, incurable illness leading to incapacity is no longer able to make decisions. If they find an advance request in the patient’s name, they must add it to the patient’s file and inform the other members of the medical staff involved in the patient’s care as well as the trusted third parties named in the request.
The process of administering medical aid in dying
The patient doesn’t receive medical aid in dying as soon as they become incapacitated. A doctor or SNP must first examine them. During the examination, they must also speak to the patient’s trusted third parties and the other members of the medical staff involved in their care.
In order to move forward with the request, the doctor or SNP must conclude that the patient:
- repeatedly experiences the symptoms described in their advance request as those that should lead to medical aid in dying,
- suffers from constant, unbearable physical or psychological pain that can’t be relieved in a tolerable way.
The doctor or SNP must write down the results of this examination. They must also inform the patient and the trusted third parties.
After the first examination is done, the doctor or SNP must get a second opinion to confirm their conclusions. Only then can the patient receive medical aid in dying.
However, the doctor or SNP won’t administer medical aid in dying if the patient refuses to receive it.
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Important! A patient may resist receiving health care because of their medical condition, not because they specifically refuse medical aid in dying. In this case, the doctor or SNP responsible for giving medical aid in dying may still administer it, even if the person resists. |