Quebec’s Advance Request for MAiD Explained - Part 2
How Quebec is overriding federal MAiD laws to support patient autonomy
Introduction
This is Part 2 of our series where we explain Quebec's new law allowing Advance Requests for Medical Assistance in Dying (MAiD). Part 1 explored the similarities and differences between Advance Requests for MAiD, general Advance Directives, and the Waiver of Final Consent. We recommend you give that a quick read here so you can understand the important differences, including why Advance Requests are needed.
This article reflects our close reading of Quebec’s Bill 11, and how we’ve interpreted what an Advance Request for MAiD is, and how they work. There’s a lot of information in Bill 11 that we don’t cover below. Feel free to ask us any questions you have in the comments below, or if you are in Quebec, contact your doctor or nurse practitioner for full details about Advance Requests for MAiD.
An Advance Request allows a person with a serious and incurable illness, like dementia, to provide consent in advance to receive MAiD after they lose capacity. Specific criteria must be met both to make an Advance Request and to receive MAiD after capacity is lost.
Please note, none of what follows should be taken as medical advice or as an indication that any individual would be eligible for MAiD or for completing an Advance Request. This overview is for informational and educational purposes only. If you or your loved ones require specific information about Quebec’s Advance Request for MAiD (and reside in Quebec), please visit the Government of Quebec website or consult your doctor or nurse practitioner.
Federal MAiD Eligibility vs Quebec's Advance Request for MAiD
It is crucial to understand the Federal MAiD eligibility criteria, as these must still be met when an Advance Request is used.
The key difference lies in the timing of when the criteria must be met during the person's illness journey. Outside of Quebec's Advance Request for MAiD, the eligibility criteria must be fulfilled at the time of the MAiD request (this is known as a contemporaneous request). As discussed in Part 1, this requirement can create a significant barrier for individuals with illnesses like dementia that eventually lead to a loss of capacity. An Advance Request overcomes this challenge by allowing eligibility criteria to be met at different stages.
Below, you will find the relevant federal MAiD eligibility criteria for reference as you continue reading. You can find the full list of criteria here.
Have a serious and incurable illness, disease, or disability
Be capable of making health care decisions for yourself
Give informed consent to receive MAiD
Be in an advanced state of decline that cannot be reversed
Be experiencing unbearable physical or psychological suffering from the illness, disease, disability, or state of decline that cannot be relieved under conditions you find acceptable.
Why are Advance Requests Needed?
A person with dementia (used here as an example of an illness that leads to incapacity) may not meet the MAiD eligibility criteria early in their disease. However, as their illness progresses to the point where they meet the criteria, they might lack the capacity to consent to receive MAiD. This situation would exclude individuals from accessing MAiD solely due to the nature of their illness, which could be seen as a violation of their Canadian Charter right to life, liberty, and security of person (section 7). Quebec's Advance Request for MAiD aims to address this exclusion.
Let's look at an example…