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Advance Directives, Advance Requests, and the Waiver of Final Consent

Quebec's groundbreaking legislation allows individuals to request Medical Assistance in Dying before losing decision-making capacity. This guide clarifies the distinctions between Advance Requests, Advance Directives, and the Waiver of Final Consent.

What is an Advance Directive?

An Advance Directive is a legally binding document outlining healthcare preferences if you lose decision-making capacity. It covers life-sustaining interventions, feeding tubes, surgeries, and palliative care measures. Any capable adult can create one, but it cannot include directions about MAiD.

Key Points

  • Communicates wishes about future healthcare decisions
  • Can be made before any specific health conditions
  • Cannot include MAiD directions
  • Available to all capable adults

Waiver of Final Consent: Audrey's Amendment

1

The Problem

Before 2021, people risked losing capacity to give final consent, forcing impossible choices about timing.

2

Audrey Parker's Advocacy

Audrey Parker died November 1, 2018, earlier than desired. She petitioned for change before her death.

3

The Solution

The Waiver of Final Consent allows MAiD provision if capacity is lost after approval but before the chosen date.

This waiver is signed with the MAiD provider, allowing medication administration on or before the chosen date if the person loses capacity to give final consent.

Eligibility for Waiver of Final Consent

*Only the MAiD provider can determine if the Waiver of Final Consent is an available option for the client.

Decision-Making Capacity

Must have capacity when signing the waiver

MAiD Approval

Already assessed and approved for MAiD under federal law

Foreseeable Death

Determined to have reasonably foreseeable natural death

Chosen Date

Selected a specific date for assisted death

Risk Assessment

Advised of risk of losing capacity before final consent

The Gap: When Neither Option Works

The Dementia Dilemma

A person diagnosed with mild dementia faces a challenge. They can't include MAiD in an Advance Directive. But do they meet current MAiD eligibility criteria?

Early dementia may not constitute "advanced state of decline" or "unbearable suffering." Prognosis measured in years may not be "reasonably foreseeable." By the time they meet criteria, they may lack capacity to consent.

Federal MAiD Eligibility Criteria

01

Serious Condition

Must have a serious illness, disease, or disability

02

Advanced Decline

Be in an advanced state of decline that cannot be reversed

03

Unbearable Suffering

Experience unbearable physical or mental suffering that cannot be relieved under acceptable conditions

In early dementia stages, meeting these criteria—particularly advanced decline and unbearable suffering—can be challenging. The disease progresses over years, creating a gap in care options.

Quebec's Solution: Advance Requests for MAiD

Bridging the Gap

Quebec's Advance Request allows individuals diagnosed with serious, incurable illnesses leading to incapacity to formally request MAiD for a future state. The request is made while capable, describing what unbearable suffering means to them.

Diagnosis

Serious, incurable illness leading to incapacity (e.g., Alzheimer's)

Request While Capable

Describe future suffering criteria in detail

Future Assessment

Medical team evaluates if criteria are met

MAiD Provision

Provided when suffering matches request description

Key Requirements for Advance Requests

1

Qualifying Diagnosis

Must have been diagnosed with a serious and incurable illness leading to incapacity to consent to care

2

Detailed Description

Must describe clinical manifestations and symptoms that will constitute consent when incapable

3

Loss of Capacity

Must have lost capacity to make medical decisions as a result of that illness

4

Lasting Suffering

Must be experiencing suffering as described in the Advance Request

The medical team, collaborating with a Trusted Third Person, assesses whether conditions align with the person's previously expressed wishes and comply with federal and provincial laws.

Comparing the Three Options

Each document serves a distinct purpose, ensuring individuals have choices aligned with their healthcare needs and values at different stages of illness.

Looking Ahead

Understanding Your Options

These legal documents address different situations in end-of-life care. Advance Directives outline general healthcare preferences, the Waiver of Final Consent protects those already approved for MAiD and met specific criteria, and Quebec's Advance Requests provide options for those facing future incapacity.

Read more about Quebec's Advance Request for MAiD by clicking the link below.