Advance request for medical assistance in dying

An advance request for medical assistance in dying (MAID) is a process by which a person requests in advance to receive medical assistance in dying in the future.

It is intended for people who have been diagnosed with a serious and incurable illness leading to incapacity (e.g., Alzheimer’s disease). The request must be made while the person is still capable of consenting to care, with a view to receiving medical assistance in dying when they become incapacitated, if all the conditions prescribed by law are met.

In other words, an advance request allows the person to give their consent in advance to receive medical assistance in dying in the future, under certain conditions, when they are no longer able to consent to receiving care.

An advance request for medical assistance in dying can only be made by a person:

• who has been diagnosed with a serious and incurable illness leading to incapacity to consent to care.
• of legal age and insured within the meaning of the Health Insurance Act.
• able to consent to care, i.e. be able to fully understand their medical situation and the information given.

Request must be made freely, without external pressure.
It must also be made in an informed manner.
The person must make it themselves and for themselves.

A person who wishes to make an AR-MAID must follow the following procedure.

• Speak with a health or social services professional to be supported in their process.
• Designate one or two trusted persons, if desired, called “trusted third parties”. Trusted third parties are individuals designated by the individual themselves, whose role is to inform the healthcare team of the existence of the advance request and of the clinical manifestations described in the request as the illness progresses. It is not mandatory to designate a trusted third party to make an advance request for medical assistance in dying.
  It is not mandatory to designate a trusted third party to make an advance request for medical assistance in dying.
• Describe in detail in their request clinical manifestations, such as symptoms, related to their illness, and which will constitute the expression of their consent to receive medical assistance in dying when they have become unable to consent to care and all the conditions provided for by law are met.
• Sign the request form in the presence of:
  • the physician or specialized nurse practitioner.
  • two witnesses, unless the request is made by notarial deed.
  • the trusted third party(ies), if any..

When the advance request for medical assistance in dying is made in front of witnesses, the person does not have to disclose its content to them.

To be valid, the advance request must be filed by the physician or specialized nurse practitioner in the register provided for by law with the Régie de l’assurance maladie du Québec (RAMQ). No copies are permitted.

A person who is capable of consenting to care may withdraw or modify their request at any time:

• by being accompanied by a physician or specialized nurse practitioner who will ensure that they are still able to do so because they are still capable of consenting to care;
• by using the form provided for this purpose.

To modify an advance request for medical assistance in dying, the person must make a new one. As soon as it is filed in the register, the new request will replace the one previously written.

To obtain medical assistance in dying following an advance request, the requesting person must meet all of the following conditions:

● have made a request in accordance with the law, and therefore meet the above-mentioned criteria (be suffering from a serious and incurable illness leading to incapacity to consent to care, be of legal age, and be insured);

● have become incapacitated to consent to care due to their illness;

● have recurrently exhibited the clinical manifestations related to their illness and described in their request;

● have a medical condition that brings a competent professional (doctor or specialized nurse practitioner) to believe, on the basis of the information available to them and according to the clinical judgment they exercise, that they are experiencing persistent and unbearable physical or psychological suffering. This suffering must not be able to be relieved under conditions deemed tolerable.