Preparing for MAID

The medical assistance in dying procedure involves a number of distinct, well-defined stages to ensure that the applicant’s wishes are respected, while applying the indications set out in the law: the medical assistance in dying procedure begins at the time of application and ends with the administration of care to the eligible applicant.

The health care professional’s role is not to evaluate the request. Their role is simply to complete the form with the applicant and forward it to the integrated university health and social services centres (CIUSSS) or integrated health and social services centres (CISSS) in the applicant’s region.

Ethics and the law are clear: every citizen has the right to have his or her MAID application assessed. The health care professional cannot refuse to complete the request form or neglect to forward it. It should be noted that conscientious objection allows a physician or a specialized nurse practitioner (SNP) to refuse to assess a person’s eligibility for MAID or to proceed with care, but does not give him or her the right to refuse to transmit a MAID request form.

First of all, a person wishing to obtain MAID must make an oral request to a health care professional of his choice who is employed by the Ministère de la Santé and holds a permit to practice number. This could be a family physician, nurse, pharmacist, social worker, psychologist or physiotherapist, to name but a few. This health care professional does not need to know the applicant’s medical history; he or she simply needs to be able to identify the applicant with his health insurance card.

To confirm your wish to obtain MAID, you must then complete and sign the request form for MAID with the health care professional, in the presence of an independent and validly-recognized witness.

A witness is not recognized and independent if they:

• Is not of legal age and capable.
• Know or believe that they are a beneficiary under the will of the person making the request.
• Believe that they will receive some benefit as a result of the death of the person who made the request for MAID.
• Are an owner or operator of any health care facility at which the person making the request is being treated or any facility in which that person resides.

If the person requesting MAID cannot sign and date the form, a third party can do so in their presence and according to their directives. However, the authorized third party must meet the following conditions:

• Be over 18 and capable.
• Understand the nature of the request for MAID.
• Not know or believe that their are a beneficiary under the will of the person requesting MAID, or that their will receive other material benefits as a result of the person’s death.

Once the application form has been received by the CIUSSS or CISSS, an assessor (physician or specialized nurse practitioner (SNP)) is responsible for evaluating the applicant’s eligibility. Their contacts the applicant to set up an initial appointment to ensure that he meets the eligibility criteria. This usually takes from 1 to 15 days.

To learn more about the eligibility criteria for MAID, please click on the following button.

If this assessor deems that the applicant meets the criteria, their will ask a second assessor to assess the patient. It is not the applicant’s responsibility to do this. The second opinion may be given by a specialist nurse practitioner (SPN), an attending physician or a consultant physician you have met.

Only once eligibility has been confirmed by both assessors can the MAID procedure continue. At this point, the first assessor returns to the applicant to determine, with him or her, the date on which their will receive the treatment, as well as all the related details: time, place, people present, etc.

The first assessor is usually the provider who administers the patient’s MAID.

If a patient’s request is denied, he or she can request another assessment without waiting.

To determine how long the MAID procedure will take, various factors must be taken into account, depending on the applicant’s situation and condition.

Many applicants wonder how long the whole process of MAID will take? Although it’s difficult to establish a time frame that applies to all applicants, there are certain time frames to be aware of, depending on the situation.

When it comes to MAID, it is important to first assess whether or not the applicant’s natural death is considered reasonably foreseeable, i.e. whether death can occur naturally within a relatively foreseeable timeframe. This will influence the time required to administer care. It is the assessor who determines this point.

If death is foreseeable, the applicant can receive care the day after the request is made, with no waiting period. On the other hand, if death is not foreseeable, the statutory waiting period is 90 days from the date of the first assessment by the first assessor.

Final consent, in the context of MAID, refers to the patient’s voluntary and informed approval at the time of receiving care. It confirms the patient’s willingness to undergo end-of-life care.

The physician or specialized nurse practitioner (SNP) providing MAID has a legal obligation to seek the patient’s consent before beginning the injection process.

In the case of reasonably foreseeable death, however, the patient is able to waive their final consent, if, for example, their fears losing the autonomy to consent due to their health situation or the medication their is taking to avoid suffering. To waive consent, the applicant must complete the statutory waiver of final consent form with his or her medical aid in dying provider.

A person requesting MAID is always free to change their mind, and may do so at any time:

• Withdraw is request for MAID.
• Request a postponement of the administration of MAID.

MAID is administered by injection, and is governed by a number of preparatory elements that must be defined by the applicant beforehand.

A number of preparations must be made before receiving MAID, and the person making the request can choose several details: the date and time their wishes to receive the treatment, the atmosphere their wishes to give it (ceremony, music or other), the loved ones who will be present, and the place where the treatment will be administered.

There are several possible settings for the treatment. It can take place in a hospital, in a palliative care home or, if the person so wishes, they can under certain conditions receive care at home or in a suitable place of their choice.

You should also know that funeral arrangements can be made at any time before or after MAID, but it is imperative that the funeral home be chosen before MAD. The funeral home must collect the deceased’s body once the MAID has been administered, whether at home, in hospital or elsewhere.

The provider (physician or specialized nurse practitioner (SNP)) must be informed of this, and the applicant can also express their wishes regarding organ donation if their is considering it. In this case, the provider will put the applicant in touch with Transplant Québec, and it takes at least 2 to 3 weeks of procedures before MAID can be given.

First and foremost, to facilitate the administration of the drugs used in the treatment, a catheter is placed on the patient by the nursing staff. This is usually done the day before or the same day.

MAID is administered by injection. The MAID provider will use a total of 4 drugs. The entire process is rapid, usually lasting only a few minutes. The first injection of Midazolam is designed to induce sleep. The provider then injects a local anesthetic to avoid venous discomfort. In the third stage, Propofol is injected to plunge the patient into a deep coma. The final injection of a curare stops the patient breathing.

The Quebec government’s health and wellness web portal  includes several pages dedicated to end-of-life care. It provides valuable information about end-of-life provisions in Quebec law. Changes required by federal law have been incorporated into this content.