Requirements for receiving medical aid in dying following a contemporaneous request

According to the Act Respecting End-of-Life Care, the term "competent professional" refers to a physician or specialized nurse practitioner. The competent professional must comply certain obligations before administering medical aid in dying.

1. They must first ensure that the person requesting medical aid in dying meets all of the criteria set out in the Act, by:
   • making sure that the person is making the request freely and not as a result of external pressure
   • making sure that the person fully understands the seriousness of their request (informed request), in particular by informing them of the prognosis of their illness or of the anticipated clinical course of their physical impairment considering their condition, the therapeutic possibilities and their consequences, or the appropriate measures to compensate for their disabilities
   • verifying the persistence of suffering and that the wish to obtain medical aid in dying remains unchanged by talking with the person at different times. These discussions must be held at reasonably spaced intervals given the progress of the person’s condition
   • discussing the person’s request with any members of the care team who are in regular contact with the person
2. The professional must discuss the person’s request with their close relations or any other person they identify, if the person wishes.
3. The professional must ensure that the person had the opportunity to discuss their request with those they wanted to contact.
4. If the person has a physical impairment, they must make sure that the person has assessed the possibility of obtaining support, advice or assistance services. These services may be obtained from the Office des personnes handicapées du Québec, a community organization or a peer assistant, such as assistance in initiating a service plan process for them.
5. They must obtain the opinion of a second independent physician or specialized nurse practitioner, confirming that the criteria for obtaining medical assistance in dying have been met. The second physician or specialized nurse practitioner must be independent of both the person requesting medical aid in dying and the professional seeking the opinion.

Since June 11, 2021, the Act Respecting End-of-Life Care allows a person at the end of life, who has made a contemporaneous request, to receive medical aid in dying if they become incapable of consenting to care between the time when all the criteria are met and when the care is administered. Special requirements must be met to receive medical aid in dying in this context. For example, the person must have consented to this aid in writing in the presence of a physician or a specialized nurse practitioner within 90 days before the date of administration of medical aid in dying. This does not constitute an advance request for medical aid in dying.

Health professionals must not ignore a request for medical aid in dying. However, a physician or a specialized nurse practitioner may refuse to administer medical aid in dying because of their personal values. The physician or specialized nurse practitioner must notify, as soon as possible, the executive director of the institution (or its designated person), who will take the necessary steps to find quickly another physician or specialized nurse practitioner to handle the request. The physician or specialized nurse practitioner must also ensure continuity of care provided to the person, in accordance with the provisions of their code of ethics and with the person’s wishes.

Other health or social services professionals may also refuse to take part in the administering of medical aid in dying for the same reasons. They, too, must notify the responsible authorities, who will make sure that the required care and support are provided to the person and their close relatives.

If you are in a situation that is causing you suffering, do not hesitate to consult a health or social services professional for support, or call 811 if you don't have access to such a professional.