The Act lays down very restrictive conditions that patients must meet to receive medical aid in dying, regardless of where they are receiving care. Several procedures must also be followed by doctors and health and social services institutions both before and while they provide this care.
The administration of medical aid in dying is possible only if all of the following requirements are met, for both the person and the doctor.
For a person wishing to obtain medical aid in dying
Only a person who meets all of the following criteria may obtain medical aid in dying:
Be insured according to the Health Insurance Act
Be at least 18 years of age
Be capable of giving consent to care, which means the person must be able to understand the situation and the information given by health professionals as well as make decisions
Suffer from a serious, incurable illness
Be in an advanced state of irreversible decline in capability
Experience constant and unbearable physical or psychological suffering that cannot be relieved in a manner the person deems tolerable.
According to the Act respecting end-of-life care, doctors must comply with various obligations before administering medical aid in dying.
They must first ensure that the patient requesting medical aid in dying meets all of the conditions prescribed.
Make sure that the patient is making the request freely and not as a result of external pressure
Make sure that the request is an informed one, in particular by informing the patient of the prognosis for the illness and of other therapeutic possibilities and their consequences
Verify the persistence of suffering and that the repeatedly expressed wish to obtain medical aid in dying remains unchanged by talking with the patient at different times. These discussions must be held at reasonably spaced intervals given the progress of the patient’s condition
Discuss the patient’s request with any members of the care team who are in regular contact with the patient
Discuss the patient’s request with his or her close relations, if the patient so wishes
They must make sure that the patient has had an opportunity to discuss the request with the persons that he or she wished to inform.
They must obtain the opinion of a second – independent – doctor confirming that the conditions for obtaining medical aid in dying are met.
The doctor who administers medical aid in dying must be independent, with respect to both the person who made the request and the second doctor. The second doctor must also be independent of the person who made the request for medical aid in dying.
Ability to consent to care
As of June 11, 2021, the Act respecting end-of-life care allows people at the end of life who meet all criteria for receiving medical aid in dying to receive this aid even if they have become incapable of consenting to the care at the time aid is administered. However, these people must have consented to receive this care in writing in the presence of a healthcare professional within 90 days before the date of administration of medical aid in dying.
Health professionals must not ignore a request for medical aid in dying. However, a doctor may refuse to administer medical aid in dying because of his or her personal values. The doctor must notify, as soon as possible, the executive director of the institution where the patient resides, who will take the necessary steps to find quickly another doctor who is willing to administer medical aid in dying. The doctor must also ensure continuity of care for the patient, in accordance with the provisions of his or her code of ethics and with the patient’s wishes.
Other health 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 patient and his or her loved ones.