Quebec announced in September 2024 that provisions allowing advance requests for medical aid in dying would take effect on October 30, 2024. The change concerned a tightly regulated request made by an eligible person while capable, for possible use only after a serious and incurable illness has made that person incapable of consenting to care.
Who may make an advance request
A person must already have been diagnosed with a serious and incurable illness that will lead to incapacity, such as Alzheimer’s disease. The law does not allow someone to submit a request merely in case such an illness might be diagnosed later. At the time of the request, the person must be an adult, insured under Quebec’s Health Insurance Act and capable of understanding the medical information and communicating a free and informed choice.
The request must be the person’s own. It is separate from an advance medical directive, a living will or an informal written or recorded statement. Those instruments can address other care decisions but cannot substitute for the prescribed advance-request process.
The formal process and safeguards
The form is available only through a physician or specialized nurse practitioner who assists with the request. The person must describe observable clinical manifestations associated with the diagnosed illness. Those descriptions express the circumstances in which consent given in advance could later become relevant.
The form is signed in the presence of the assisting professional and two witnesses, unless it is completed as a notarial act. A person may optionally designate one or two capable adult “trusted third persons.” Their role is to make the request known and alert health or social-services professionals when the specified situation may have arisen; they do not make the decision for the patient.
For validity, the request must be recorded in the statutory register by a physician, specialized nurse practitioner or notary. A capable person may withdraw it or replace it with a new request. Simply signing a request does not guarantee that medical aid in dying will later be administered.
What must be established later
After the illness has caused incapacity, the person must repeatedly exhibit the clinical manifestations described in the request, be in an advanced and irreversible decline, and have a condition that gives a competent professional reason to believe the person is experiencing enduring and unbearable physical or psychological suffering that cannot be relieved under conditions considered tolerable. A second physician or specialized nurse practitioner must independently confirm that the legal criteria are met.
Professionals must consult the register and assess the person’s actual condition. The framework therefore is not a scheduled procedure triggered automatically by diagnosis, passage of time or a relative’s preference. It combines the person’s earlier informed instructions with a later clinical assessment.
The federal-law issue in 2024
Criminal law is federal, while Quebec regulates health care through its end-of-life statute. Because the federal Criminal Code had not created a matching advance-request exemption, Quebec’s Director of Criminal and Penal Prosecutions issued guidance on prosecutorial discretion. It said a prosecution would not be in the public interest when all evidence confirmed that care had respected the freely and informed wishes and Quebec’s statutory conditions. The guidance did not amend the Criminal Code or remove the need for rigorous case-by-case review.
The precise description is therefore “advance requests,” not a general permission for early or automatic MAID. Anyone considering the process should use current Quebec government information and obtain professional medical and legal guidance; this archived policy report is not individualized advice.
