What does it mean to “die with dignity”? In Quebec, this question helped shape the rules around end-of-life care and medical aid in dying (MAID). Here’s how these rules have evolved, leading to advance requests for MAID.
Since 2014, the rules around end-of-life care have changed significantly. They give an important place to a person’s autonomy and wishes.
Advance medical directives and medical aid in dying
In 2014, Quebec adopted the Act respecting end-of-life care. Among other things, this law allows people to express their wishes through advance medical directives and to receive medical aid in dying (MAID) in certain situations and under certain conditions.
Advance medical directives let you say in advance whether you accept or refuse certain healthcare in specific medical situations. They must be followed when a person no longer has legal capacity to give consent.
MAID is different. A healthcare professional gives medication to a person, at their request, to relieve their suffering. The medication causes the person’s death.
With this law, Quebec was the first province to allow “contemporaneous” requests for MAID as part of its health-care system, even before federal law allowed it. At the time, MAID was still prohibited under Canada’s Criminal Code.
At the federal level, changes came in 2015. The Supreme Court of Canada released its decision in Carter v. Canada. It found that certain provisions of the Criminal Code prohibiting MAID violated rights guaranteed by the Canadian Charter of Rights and Freedoms. Following this decision, in 2016, the Government of Canada modified the Criminal Code to decriminalize MAID under certain conditions. Among other things, only people whose natural death was “reasonably foreseeable” could request MAID.
In 2021, the federal rules changed again. The Criminal Code no longer requires a person’s natural death to be reasonably foreseeable to receive MAID. There are now two sets of rules: one for situations where a person’s natural death is reasonably foreseeable and another for situations where it is not.
Advance requests for medical aid in dying
In 2023, Quebec passed a law allowing advance requests for MAID as of October 30, 2024.
An advance request allows a person to request MAID in advance, while they have legal capacity to consent to care. The request can later be carried out if the person becomes incapable of giving consent because of their illness and the other conditions set out in the law are met.
This is what distinguishes an advance request from a contemporaneous request. With a contemporaneous request, the person generally must still have legal capacity to give consent when they receive MAID.
Quebec has gone further than the federal framework on this issue. For now, under federal law, the Criminal Code doesn’t allow advance requests for MAID. The federal government held a national consultation on this issue in 2024 and 2025. The federal framework could therefore still change.