Excerpt and summary from the Government of Quebec website
The advance request for medical assistance in dying (AR-MAID) is made by a person who has been diagnosed with a serious and incurable illness leading to incapacity (for example: Alzheimer’s disease).
This request must be made while the person is still able to consent to care. The advance request allows the person to receive medical assistance in dying in the future, under certain conditions, when they are no longer able to consent to receiving the care.
A – For the person who wishes to make an advance request
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.
B – Procedure for making an advance request for medical assistance in dying
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”. Their role is to ensure that the wishes of the person expressed in their advance request for medical assistance in dying can be known and respected, if all the conditions provided for by law are met.
These people must ensure that health or social services professionals are aware of the existence of the advance request for medical assistance in dying and inform them when they notice certain situations.
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.
C – Withdrawing or modifying your advance request for medical assistance in dying
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.
D – Requirements to receive medical assistance in dying when an advance request has been made in accordance with the law
Only a person who meets all of the following conditions, in addition to having made a request in accordance with the law, may obtain medical assistance in dying following an advance request. They must therefore:
- have a serious and incurable illness leading to incapacity to consent to care;
- be incapacitated to consent to care due to their illness;
- be of legal age and an insured person within the meaning of the Health Insurance Act, with certain exceptions provided for by law;
- have, on a recurring basis, the clinical manifestations related to their illness and described in their request;
- have a medical situation characterized by an advanced and irreversible decline in their capacities.
- have a medical situation that gives rise to a competent professional (physician or specialized nurse practitioner) to believe, based on 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.
Second opinion: in addition, a second physician or specialized nurse practitioner must confirm compliance with these conditions.
It is possible to receive medical assistance in dying only if all the conditions of the law are met.