Since October 30, 2024, a new option has been offered regarding medical assistance in dying: advance request. For many people diagnosed with dementia, it is a “preventative” decision. However, I notice in my practice that the difference between this advance request and advance medical directives is not always well understood. Let’s clarify the situation.
Advance medical directives (AMD) allow a person to express their wishes in anticipation of a possible inability to consent to care. They apply to specific situations, such as the end of life or the considerable and irreversible loss of cognitive functions (a permanent coma, for example). We are talking here about cardiopulmonary resuscitation, assisted ventilation, dialysis, as well as artificial nutrition and hydration. To consent or refuse this care in advance, simply complete an online form, without the presence of a health professional, and without having a specific diagnosis. These directives take precedence over any other form of expression of wishes in the event of incapacity to consent to care.
For the advance request for medical assistance in dying (DAAMM), consider the case of Ginette, 67, who suffers from Alzheimer’s disease. Accompanied by her partner, in my office, she tells me: “I would like to apply for MAID. I don’t want to end up in a CHSLD and no longer recognize anyone. » Such a request requires careful preparation. Ginette meets the first condition: being suffering from a serious and incurable illness leading to the incapacity to consent to care. I also make sure that, for the moment, she still has all her lucidity, because it is imperative to be able to formulate this type of request.
Then, I inform the couple of the steps of the process, because several consultations are necessary before signing the final document. A guide is also available for the person concerned and their loved ones. I ensure that Ginette makes her request with full knowledge of the facts and of her own free will. She must have all the information concerning her illness, its symptoms, its progress, as well as the treatments and care available to relieve her suffering. This will allow him to understand the consequences of his illness which could lead him to consider medical assistance in dying.
-The following appointments serve precisely to detail the clinical manifestations that Ginette considers intolerable. I explain to him that having to live in a CHSLD is not an admissible condition. However, no longer being able to walk, being bedridden, suffering from incontinence and no longer being able to eat alone, among other things, could be part of it. Once the application is completed, it must be signed in the presence of two witnesses or as a notarial deed and then sent to the registry. It is always possible to modify or cancel a request, as long as you maintain your capacity to consent to care.
This request does not guarantee that my patient will necessarily receive medical assistance in dying. To obtain it, Ginette must become incapable of consenting to care, and this incapacity must be linked to her Alzheimer’s disease. The claim will not apply if she becomes incapacitated following a stroke, for example. In addition, there must be the presence of the clinical manifestations in question, accompanied by persistent physical and psychological suffering, unbearable and impossible to relieve.
As we can see, a DAAMM is a complex, personalized procedure, which requires monitoring by a qualified person. Although many requests are expected to be submitted, few of these are likely to be implemented.
