MAID stands for “medical assistance in dying” or “medical aid in dying,” which are both the same thing. This is a procedure governed by rigorous criteria outlined in both provincial and federal law. 

During the MAID procedure, the provider* administers substances that will cause the death of a patient who is suffering from a grievous and incurable illness that has become intolerable to them, thus putting an end to their physical or psychological suffering. The law offers each person the opportunity to decide how they want their end-of-life to be, in accordance with their values and their dignity. 

*The term “provider” refers to the physician or specialized nurse practitioner (SNP) who assesses the applicant and provides the MAID care.

Two kinds of MAID are permitted in Canada, outside of Quebec. The first is when a physician or specialized nurse practitioner (SNP) directly administers a substance that causes the death of the person who has requested it (“medical assistance in dying”). The second is when a physician or a SNP gives or prescribes to a patient a substance that the patient can self-administer to cause their own death (“self-administered medical assistance in dying,” sometimes referred to as “assisted suicide”). NB: it is worth noting that the latter term, “assisted suicide,” is a stigmatizing expression that should be avoided.

In Quebec, only a physician or a specialized nurse practitioner (SNP) can administer medication and cannot, under any circumstances, delegate this act to another person, whether they are a resident or a nurse.

Self-administered MAID is illegal in Quebec, but is legal in the rest of Canada.

In some cases, palliative care and other therapeutic means may fail to alleviate the patient’s suffering. In these circumstances, MAID becomes an option. MAID and palliative care are in no way contradictory. Instead, MAID is one of the healthcare options provided within a palliative spectrum.

MAID has been legal in Quebec since Act 2 was passed on June 5, 2014, and came into effect on December 20, 2015. It has been legal in Canada since Bill C-14 was passed to amend the Criminal Code, on June 17, 2016.

The September 11, 2019, judgment rendered by Justice Baudouin of the Superior Court of Quebec states that both the “end of life” term used in Quebec law and the “reasonably foreseeable natural death” term listed in criteria for access to MAID are unconstitutional, due to the Supreme Court judgment made February 6, 2015.

Since then and since the March 17, 2021, Criminal Code amendment, the conditions are as follows:

• All criteria under Quebec law have remained the same, except the one requiring that a patient be in their end of life, which is no longer operational.
• As for the (federal) Criminal Code, “reasonably foreseeable natural death” is no longer an eligibility criterion for MAID but has become a safeguard measure to separate patients into two categories:

• Persons whose natural death is reasonably foreseeable, like a patient with metastatic cancer.
• Persons whose death is not reasonably foreseeable (over time), given their illness. This includes, for instance, patients with a degenerative neurological disease like multiple sclerosis, where natural death is not reasonably foreseeable (short- or medium-term prognosis), but it is known that the illness will lead to the patient’s death. Once again, this is no longer an eligibility criterion but rather a safeguard meant to differentiate patients.

In a nutshell, a patient requesting MAID must meet all other legal criteria but does not need to be at the end of their life. Furthermore, neither Quebec law nor federal law specify a time limit. For instance, a patient with advanced rheumatoid arthritis that will not cause their death within the next two to five years might still be eligible for MAID if all other criteria are met.

You cannot do this in Quebec, where self-administered MAID is not legal. It is allowed, however, in the rest of Canada.

In Quebec, in the event of a serious illness, you can request and receive MAID with complete peace of mind if you meet the legal criteria. It will be administered by a physician or a specialized nurse practitioner (SNP).

In Canada, outside of Quebec, a physician or a SNP can administer MAID to you. A physician can also prescribe medication that you would take in front of him or her.

Eligibility criteria for access to MAID in Quebec:

• The person is insured according to the Health Insurance Act;
• The person is at least 18 years of age and capable of giving consent to care;
• The person is suffering from a serious and incurable disease;
• The person’s medical condition is in an advanced state of irreversible decline in capability;
• The person is experiencing constant and unbearable physical or psychological suffering that cannot be relieved in a manner that they deem tolerable.

The Criminal Code of Canada, for its part, specifies that “a person has a grievous and irremediable medical condition only if they meet all of the following criteria:

• They have a serious and incurable illness, disease or disability;
• They are in an advanced state of irreversible decline in capability;
• That illness, disease or disability or that state of decline causes them enduring physical or psychological suffering that is intolerable to them and that cannot be relieved under conditions that they consider acceptable.”

Yes, a person diagnosed with a cognitive neurodegenerative disease can apply for MAID if they wish.

However, four criteria must be met and confirmed by a physician:

• The person must have been diagnosed with a physical, serious and incurable disease: this is the case for Alzheimer’s, Parkinson’s (or any other cognitive neurodegenerative disease).
• The person must have experienced a significant decline in their abilities: a decline that is necessarily irreversible, given the disease.
• The person must present, in their own opinion, intolerable, uncontrollable and unappeasable suffering, whether physical or psychological: in the case of Alzheimer’s, we speak of psychological or existential suffering expressed by the patient.
• The person must be capable of consenting to care: an aptitude which, in the case of Alzheimer’s, will gradually disappear.

Yes, but this person must meet all the eligibility criteria listed above. In other words, a person who has a physical illness that meets the criteria, in addition to a mental health problem, can access MAID as long as they have the capacity to consent.

However, a person suffering from only a mental illness, without another medical condition, will not be eligible for MAID until March 17, 2027, according to the Canadian Criminal Code. Legislation will need to be developed by this date, to address such requests.

The patient can receive MAID only if they are insured according to the Health Insurance Act and are registered with the Régie de l’assurance maladie du Québec (RAMQ).

First of all, you’ll need to express your request to a health care professional and fill in a MAID request form.

You will need to complete and sign your MAID request form with the health care professional of your choice. The only condition is that they must be employed by the Ministry of Health and hold a license to practice number. This could include your family physician, a nurse, a pharmacist, a social worker, a psychologist or a physiotherapist, to name but a few. The health care professional you choose to complete your application does not need to know your medical history. Their simply needs to be able to identify you using your health insurance card. Their role is not to evaluate the claim, but simply to complete the form with you and forward it to the CIUSSS or CISSS in your region.

It is not necessary to write the name of the physician or specialized nurse practitioner (SNP) who will perform the MAID on the form, unless the physician or SNP who signs your request also agrees to perform the treatment.

Once the form has been received, the CIUSSS or CISSS will forward the request to a physician or a SNP assessor who will meet with you to assess whether you meet the medical and legal criteria. This process should normally take no more than 1 to 2 weeks following your application.

Thereafter, if the first physician or SNP assessor deems that you meet the criteria, a second physician or SNP will assess you, either in person or on file by contacting you by telephone.

Once your eligibility has been confirmed by both assessors, the first physician or SNP who carried out your formal assessment will become your MAID provider, and it is with this person that you will determine the date on which you wish to receive the care, as well as all the elements involved.

There is no mandatory waiting period between requesting and receiving MAID.

If your case falls in category 1 under federal law, the “reasonably foreseeable natural death,” you may receive MAID from the day your request was made, as long as a second physician has also provided their opinion. There is no maximum waiting time.

If the physician performing the assessment deems your case to be within the scope of a “natural death that is not reasonably foreseeable,” a 90-day waiting period will apply between the time of the first assessment by a physician (whether it was made based on your records, online, or in person) and the time MAID will be administered. There is no maximum waiting time, but everything is dependent on whether the patient is able to reiterate their request for MAID and to understand it.

To summarize, if your case involves a natural death that is not reasonably foreseeable, you will be allowed to receive MAID starting from the 91st day, but will not be required to do so. You can get it six months later, if you want to; but, of course, you will still need to have the capacity to consent.

Yes, of course, because in most circles, professionals do know each other. It is important, however, that they be independent of each other within the meaning of the law and “with respect to the person applying for MAID (Article 29 (3) of the LCSFV; section 242.2 (3) (e) and (f) of the Criminal Code). It is critical to avoid situations that could influence and bias their professional judgment.” 

– Guide d’exercice et lignes directrices pharmacologiques, Collège des médecins du Québec, updated in November 2017.

The Criminal Code specifies that, in the context of a MAID request, the provider* MAID and the medical practitioner providing the opinion are independent if they:

1. are not a mentor to the other practitioner or responsible for supervising their work;
2. do not know or believe that they are a beneficiary under the will of the person making the request, or a recipient, in any other way, of a financial or other material benefit resulting from that person’s death, other than standard compensation for their services relating to the request; and
3. do not know or believe that they are connected to the other practitioner or to the person making the request in any other way that would affect their objectivity.

This rule also applies to specialized nurse practitioners (SNP).

The provider* who assesses the patient, in a hospital, for instance, may be accompanied by their resident or a physician in training for MAID. What matters is that the provider* providing the second opinion is independent of the first within the wording of the Criminal Code. Furthermore, it is important to specify that the opinion of the second provider must be objective and impartial and must not be influenced by his or her personal convictions. “A doctor whose personal convictions of a moral or religious nature prevent them from participating in the MAID process should refrain from participating in this second consultation.” 

– Guide d’exercice et lignes directrices pharmacologiques, Collège des médecins du Québec, updated in November 2017.

*The term “provider” refers to the physician or specialized nurse practitioner (SNP) who assesses the applicant and provides the MAID care.

Here, directly on our website. You can also find recommendations and advice.

A witness is not independent and validly recognized if they:

• Is not of legal age and capable.
• Knows or believes that he or she is a beneficiary of the testamentary estate of the person making the request.
• Believes he or she will receive a benefit of any kind as a result of the death of the person requesting MAID.
• Owns or operates the facility where the person requesting MAID receives care or resides.

No. All persons seeking MAID must make the request themselves.

If a person requesting MAID cannot sign and date the form because they cannot write or because they are physically incapable of doing so, a third party can sign the document, in the presence of the applicant and according to certain guidelines. However, all eligibility criteria must, of course, be met, especially regarding the ability to understand what MAID means. Moreover, the provider* receiving the request will have to verify this by following a well-defined protocol.

In accordance with section 27 of the Act respecting end-of-life care and taking into account section 241.2 (4) of the Criminal Code :

Where the person requesting medical assistance in dying is incapable of dating and signing the request, a third party who is at least eighteen years of age, who understands the nature of the request for medical assistance in dying and who does not know or believe that their is a beneficiary of the testamentary estate of the person making the request or will otherwise receive a pecuniary or other material benefit from the death of the person making the request may expressly do so in their place, in their presence and according to their instructions.

*The term “provider” refers to the physician or specialized nurse practitioner (SNP) who assesses the applicant and provides the MAID care.

If the provider* performing the assessment has determined that death is reasonably foreseeable, the patient will be eligible for MAID.

If a person has been diagnosed with a physical degenerative disease and has the capacity to consent, but death is not reasonably foreseeable (short- and medium-term prognosis), this person can request MAID and receive it when they are ready. This would include, for instance, a multiple sclerosis diagnosis.

If a person has been diagnosed with a cognitive neurodegenerative disease like Alzheimer’s disease, they will be eligible for MAID as long as they have decision-making capacity. However, they will not be able to receive MAID if they have become incapacitated, even if they prepared an advance request.

*The term “provider” refers to the physician or specialized nurse practitioner (SNP) who assesses the applicant and provides the MAID care.

The “end of life” criterion is no longer an eligibility requirement, which is also the case for the “reasonably foreseeable natural death” criterion.

From the moment you are diagnosed with a physical illness that is deemed incurable or for which you do not want treatment, it is your right to request MAID. Together, you and the provider* performing the assessment will select the date that MAID will be administered.

*The term “provider” refers to the physician or specialized nurse practitioner (SNP) who assesses the applicant and provides the MAID care.

No. The patient must be the one consenting to MAID, on at least two (2) occasions: at the time of the request and immediately before receiving MAID.

However, according to federal law (Criminal Code), a patient who is deemed to have a reasonably foreseeable natural death and who is able to request MAID may, with the agreement of the provider* who will perform MAID, sign a document stating that if he or she loses their decision-making capacity, the medical practitioner will still be allowed to proceed. This is called the “waiver of final consent.”

As an example, this arrangement allows a patient who is experiencing severe pain to continue taking their medication even if this might limit, in part, their capacity to consent. The same is true of a patient who has fallen into a mild coma caused by their condition. The physician will still be able to administer MAID, after having informed the patient’s loved ones regarding the waiver of final consent.

*The term “provider” refers to the physician or specialized nurse practitioner (SNP) who assesses the applicant and provides the MAID care.

The physician or the specialized nurse practitioner (SNP) must verify that the patient has not been subjected to external pressure in their decision-making process. They will ask the patient several times if they still wish to continue with the process after having made the request. The physician or the SNP must, of course, provide all information required so that the patient can make an informed decision. Moreover, the physician or the SNP must ensure the applicant’s ability to fully understand the situation and will do so with available means like the “Nova Scotia Criteria.” The second physician or SNP must also confirm that the patient meets all MAID requirements. This ensures that the patient is making a decision out of their own free will, without outside influence.

Requesting MAID is a critical decision, one that cannot be undone once the process has been completed. To make a request, the patient must fully understand and make informed decisions regarding their health status and the care they need. In some circumstances, a patient with a mental illness may be eligible as long as they still have the capacity to consent. Eligibility is assessed by health professionals and a psychiatrist may be asked to give their opinion.

In such a context, it is obvious that a patient who does not have intellectual autonomy (due to a congenital condition or an acquired condition, like dementia) will never be able to request MAID.

Yes. You can withdraw your request at any time, up to the very last moment before MAID is administered. In fact, the physician or the specialized nurse practitioner (SNP) administering MAID is required to ask you this immediately before proceeding.

Yes. You can postpone the date upon which MAID will be administered, at any time. There is no time limit set for receiving MAID, as long as eligibility criteria are still met, especially regarding the capacity to consent, which must be clear until the very last minute.

The provider* informs the patient of the reason for refusal and records it in the patient’s file.

If a patient’s request is denied, he may request another assessment without waiting.

* The term “provider” refers to the physician or specialized nurse practitioner (SNP) who assesses the applicant and provides the MAID care.

The evaluation of a marketing authorization application is the right of all Quebecers. Ethics and the law are clear: every citizen has the right to have their MAID request assessed. The health care professional cannot refuse to complete your request or neglect to forward it.

Please note that conscientious objection allows a physician or specialized nurse practitioner (SNP) to refuse to assess a person’s eligibility for medical assistance in dying or to proceed with the care, but does not give them the right to refuse to complete and transmit your MAID request form to the CIUSSS or CISSS in your region.

If you meet the eligibility criteria, the physician who is in charge of your case and who does not want to provide this final treatment, for whatever reason, is within his or her rights. This person does, however, have an ethical obligation to refer you to another physician or SNP who will be ready to deal with your case.

According to the Collège des médecins du Québec, “the physician who receives a request for MAID is therefore required to respond to it with professionalism, whatever his or her personal convictions may be. However, under certain conditions, the physician is not required to participate in the MAID process if his or her personal convictions, of a moral or religious nature, prevent him or her from doing so. Whatever the physician’s decision may be, it must be recorded in the patient’s file.” 

– Guide d’exercice et lignes directrices pharmacologiques, Collège des médecins du Québec, updated in November 2017.

In accordance with the Code of ethics of physicians, a physician may refuse to administer MAID, but he or she must ensure the continuity of care provided to the patient. The physician must therefore immediately notify relevant authorities, who will be responsible for finding a physician willing to take on the application.

NB: The ethical obligations of IPS will be specified when available.

Please note that conscientious objection allows a physician or SNP to refuse to assess a person’s eligibility for MAID or to proceed with the care, but does not give him or her the right to refuse to complete and transmit the MAID request form to the CIUSSS or CISSS in the applicant’s region.

In Quebec, as in the rest of Canada, physicians and specialized nurse practitioners (SNP) can administer it.

MAID can be administered in a healthcare facility, at the patient’s home, or in any other location the patient chooses, as long as the dignity of the moment is respected, as well as the privacy of the applicant and his or her loved ones. This includes, for example, a hunting camp, a beach, a funeral home, etc. The choice is up to the patient.

Since December 7, 2023, all palliative care facility have been obliged to offer MAID if the patient requests it. This does not mean, however, that staff members are obliged as individuals to participate in this care – conscientious objection – but the palliative care facility cannot exclude it in advance.

It should be noted that in the majority of palliative care facilities, the patient must be admitted first to receive palliative care. Subsequently, they can apply for MAID if they so wish and if they meet all the legal criteria.

The applicant gets to decide who they want by their side at the time of their death. “Depending on the patient and what MAID means to them, the moment at which MAID is administered can be experienced between only the patient and the doctor, or it can be a shared event: if this is the patient’s wish, relatives can be present when MAID is administered, if they wish to attend. Furthermore, in accordance with the wishes of the patient, a nurse, and other members of the interdisciplinary team, or even another physician, may be present.” 

– Guide d’exercice et lignes directrices pharmacologiques, Collège des médecins du Québec, updated in November 2017.

To facilitate the administration of medication during treatment, nursing staff will install a venous catheter in advance.

As a general rule, in the case of a PICC-line central line, installation takes place at the hospital in the days preceding the treatment. In the case of standard Jelco catheters, this procedure is carried out the day before or the day of the treatment, a few hours before it takes place.

The MAID procedure from the time of the first injection, usually takes between 5 and 10 minutes.

The physician or specialized nurse practitioner (SNP) performs five injections during a MAID.

First, an injection of Midazolam creates a state of calm, drowsiness or sleep.

In the 2nd stage, the injection of an intravenous anesthetic avoids discomfort in the venous line during the injection of Propofol.

In the 3rd stage, the injection of two syringes of Propofol plunges you into a deep coma.

And in the 4th stage, the injection of a curare causes you to stop breathing.

The second kit is used in case of breakage, handling error or, if necessary, to adjust the dosage of a medication.

Remaining medications, including the second kit even if not used, must be returned in full to the pharmacist, who will dispose of them according to the usual rules.

Fortunately, since the pandemic, drug restrictions due to shortages of certain drugs have helped to improve the situation in this area, greatly reducing wastage without affecting the quality of care in any way. For example, the 2nd kit is prepared only in the usual unopened, unsyringed containers, which can be saved for another procedure.

Yes, providers* can pick up medication for MAID if it will be administered in the patient’s home. In general, however, given the type of medication used, it will most often be supplied by a hospital pharmacy. In all cases, the physician should discuss this with the pharmacist in person. Given the type of drugs to be used to perform MAID, a wait time should be expected between the time the physician makes the request for medication and the time it is delivered by the pharmacist.

*The term “provider” refers to the physician or specialized nurse practitioner (SNP) who assesses the applicant and provides the MAID care.

Any person insured according to the Quebec Health Insurance Act will have nothing to pay since all costs are covered. In fact, to “be insured” according to the law is the first eligibility criterion for MAID, which prevents medical tourism for MAID.

The family takes on a supportive role with their loved one throughout the process, from the application to MAID administration. The provider* makes sure that loved ones receive the support and help they need throughout the process.

*The term “provider” refers to the physician or specialized nurse practitioner (SNP) who assesses the applicant and provides the MAID care.

The applicant and their family can request psychological, social, and spiritual support if they wish to do so.

No. The decision is made only by the applicant and only he or she can decide whether to inform or consult family members.

No. Only the patient can make this decision. The provider* must make sure that loved ones receive the appropriate assistance and support both before and after MAID is administered.

*The term “provider” refers to the physician or specialized nurse practitioner (SNP) who assesses the applicant and provides the MAID care.

Relatives present at the time of care will have all the time they need to reflect as they wish. The provider* will be available to accompany them and answer any questions they may have.

The care team will then remove the catheters.

If the treatment takes place at home, relatives should contact the funeral home, which will organize the funeral. If the treatment takes place in hospital, the hospital will inform the funeral home.

*The term “provider” refers to the physician or specialized nurse practitioner (SNP) who assesses the applicant and provides the MAID care.

Yes, and this is a very generous gesture. The patient can donate organs and tissue, but assessment of this request and medical decisions are made on a case-by-case basis and depend on multiple medical factors. Is there cancer? Has cancer metastasized? What is the state of organ function (liver, kidney, heart, etc.)?

This decision and the assessment must also be carried out several days before MAID is administered, so that required tests can be run to verify the donor’s overall physiological state.

It is important to know that to allow for an organ donation, MAID needs to be administered under special conditions, in the hospital, usually in an operating room. All personnel working in this room understand that they must give the patient’s loved ones the space that they need, so that the process can be carried out with tact, allowing loved ones to take their time. However, time spent with the deceased must be well regulated and quick, at the start of the procedure. All members of the medical and surgical team will be able to accompany you with the utmost respect.

Advance medical directives are written instructions, in which a person of full age and with the capacity to consent, states which medical care they accept or refuse to receive in the event that they lose the capacity to consent to care in certain specific clinical situations.

According to Act 2 on End-of-life care, section 51:

A person of full age who is capable of giving consent to care may, by means of advance medical directives, specify whether or not they consent to care that may be required by their state of health, in the event they become incapable of giving consent. 

However, in such directives the person may not request medical aid in dying.

Therefore, under the law, it is not possible to request MAID in advance medical directives.

This is a form provided by the Government of Quebec. It must be filled out by you and signed by you and by two adult witnesses. This document is sent to the MSSS digital files, which are accessible everywhere in the network, therefore in all health establishments. The document is binding for all medical staff, which means they are required to abide by it.

To receive your personalized form, you have several choices:

Visit the RAMQ website.

Or type this into your search engine: Advance medical directives.

Or by phone:

• Quebec: 418-646-4636
• Montreal: 514-864-3411
• Elsewhere in Quebec: 1-800-561-9749

Before requesting your form from the Régie, we strongly recommend that you become fully informed about advance medical directives, by reading the Advance medical directives section of the Government of Quebec website.

Only if you want to. You can choose to consult a notary who will record your wishes in a notarial deed, which presents the same content as the Advance Medical Directives form prescribed by the Ministry. At your request, the notary will send the notarial act to the RAMQ to have it filed in the Register for advance medical directives.

You can also send the form to your physician or a healthcare professional so that they can place it in your medical file. If applicable, tell your relatives where you filed your notarial deed.

The notary can check with you that no conflict exists between the wishes you expressed elsewhere and your advance medical directives. The notary can also answer your questions regarding legal matters.

The only important point is that you send the form to the government yourself so that your directives will be entered in the Register.

If you have filled out the official government form, this document will be submitted to the MSSS digital files, which are accessible across the network, therefore in all health establishments. The document is binding for all medical staff, which means they are required to abide by it.

According to section 58 of the same Act 2:

When a person is incapable of giving consent to care, clearly expressed instructions relating to care that are recorded in the advance medical directives register or filed in the person’s record carry, for all health professionals having access to the register or record, the same weight as wishes expressed by a person capable of giving consent to care.