In Quebec and elsewhere in Canada, an eligible person may request medical aid in dying (MAiD). However, most people are unfamiliar with the formal process and procedure for formalizing this type of request.
Medlégal’s health lawyers are here to share important information about how to ask for medical assistance in dying.
Medical aid in dying: definition
Medical aid in dying (MAiD) refers to the process by which a healthcare professional intentionally administers a medicinal substance or performs an act to end a person’s life at their request, within the framework of criteria and procedures established by law. In Quebec, MAiD is governed by the Act Respecting End-of-Life Care, which came into force on December 10, 2015, making the province the first jurisdiction in Canada to legalize this practice.
Requirements for requesting medical aid in dying
The requirements for medical aid in dying are highly restrictive. The process also involves a number of strict procedures that doctors and health-care institutions must follow.
General conditions for requesting medical aid in dying
A person who wishes to receive medical assistance in dying must meet a wide range of conditions, which are as follows:
- Be 18 years of age or older
- Be capable of consenting to care
- Give their free and informed consent
- Be insured within the terms of the Health Insurance Act
- Suffer from an incurable and serious illness
- Suffer from an advanced and irreversible decline in capacity that cannot be relieved by any available medical treatments.
Please note that a mental disorder other than a neurocognitive disorder can cause severe suffering but is not considered a serious incurable disease. This type of disorder does not make you eligible for MAiD.
Until recently, the person requesting MAiD had to be facing a reasonably foreseeable natural death to qualify. Now, this requirement is considered unconstitutional. If you are not facing foreseeable natural death, you could receive MAiD by obtaining a constitutional exemption. Please contact our lawyers to learn more about the context and evolution of medical aid in dying.
For the physician administering the MAiD
The physician responsible for administering medical assistance in dying also needs to follow specific rules and meet various criteria. They must:
- Make sure that the person who wishes to obtain MAiD meets all the eligibility requirements
- Make sure that the person has had the opportunity to discuss their request with the people they wish to inform
- Receive the opinion of a second independent physician to confirm that all the conditions for obtaining MAiD have been met
- Be independent, with respect to both the person who made the request and the second doctor, who also needs to be independent.
How to request medical assistance in dying
To request medical assistance in dying, an individual has to:
- Make a formal verbal request to a health and social services professional
- Submit a written request using the Request for medical aid in dying form, obtained from a health professional
- Sign the form in the presence of a health professional, which must be countersigned by the health professional and 2 independent witnesses.
The individual can do this alone or with the help of a health law firm that offers this legal service.
What happens after you file a request for medical aid in dying?
After a person has completed all necessary steps to apply for MAiD, the request is reviewed by several health professionals, including a medical specialist, to assess the patient’s eligibility and confirm their request. The purpose of these medical consultations is to verify that the patient is fully informed about their condition and the care options available. The physician will also validate the patient’s ability to self-administer the drug, if applicable.
The physician also has to make sure that the person’s loved ones receive the support and assistance they need, before, during and after the administration of the MAiD.
Once the medical consultation has been completed, there is a 10-day reflection period between the acceptance of the MAiD application and the moment when the drug is administered. Under certain conditions, this period can be shortened.
At the end of this period, the request for MAiD is re-examined to confirm that the patient still wishes to receive medical assistance in dying. If all legal conditions are met, and the patient maintains their request, MAiD may be administered.
Who can provide medical assistance in dying?
MAiD is always administered by a qualified healthcare professional, in accordance with the guidelines laid down by law and the patient’s expressed wishes. The procedure will be carried out in a respectful and compassionate manner, with appropriate support for the patient and their loved ones.
Medical assistance in dying can be provided by 2 types of health care professionals: physicians and nurse practitioners (in provinces that allow it).
In addition to these, some other professionals or individuals can help provide MAiD: pharmacists, family members, and health care providers who assist physicians and nurse practitioners in providing medical aid in dying.
Medical aid in dying: 2 options
There are 2 categories of medical aid in dying in Canada:
- The direct administration of a medication or substance that causes death.
- The prescription of a drug that causes death that the eligible person takes themselves. It is important to note that this option is not currently allowed in Quebec.
Protective measures for the patient
Before proceeding with medical assistance in dying, a physician must ensure that the patient complies with several protective measures. These include:
- Confirming that the patient has discussed their decision with their loved ones, and, if desired, that their loved ones have had the opportunity to discuss it with a doctor
- In the event that the patient has difficulty expressing themselves, providing a reliable means of communication and confirming that the patient has fully understood all information given them
- Verifying that the patient has reiterated their request for medical assistance in dying at different points in time
- Confirming that the patient gives their express consent immediately before receiving MAiD and respecting that they retain the right to withdraw this consent at the last moment.
Medical assistance in dying: can you change your mind?
A person who applies for medical assistance in dying can change their mind at any time. They can either withdraw their application or postpone it.
Where is MAiD offered?
Medical assistance in dying can be requested anywhere in Canada. How and where this service is provided depends on the provinces and territories, the organizations responsible for supervising health care professionals, and medical facilities.
Medical aid in dying: making an informed decision
Medical assistance in dying is offered everywhere in Canada. The process is very strict and must be well thought out since it requires the free and informed consent of the person who wishes to obtain it.
Contact us if you need help understanding the legal implications of medical aid in dying.
We invite you to read the following related article: Does a patient have the right to refuse vital medical treatment?
