OTTAWA — Dr. Laurent Boisvert has fulfilled advance requests for assisted deaths a handful of times.
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Boisvert → fulfil → times
Once, he chose not to follow through.
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he → choose → ?
Dr. Claude Rivard has provided MAID to patients with advance requests on three occasions.
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Rivard → provide → occasions
He says sometimes he feels like a “trickster” when he helps end the life of a person who can’t consent to the procedure.
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who → say → procedure
Dr. Mathieu Moreau has never drafted or completed an advance request.
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Moreau → draft → request
The Montreal-area physicians work in the only province in Canada where a person with a “serious and incurable illness leading to incapacity,” such as dementia, can request medical assistance in dying months or years before they become incapable of doing so.
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they → work → assistance
All three physicians, who have performed MAID on consenting patients, believe that in the right circumstances and with appropriate safeguards, advance requests are simply the compassionate thing to do.
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requests → perform → safeguards
But as Ottawa moves to decriminalize such requests — a plan
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Ottawa → move → requests
the Carney Liberals announced earlier this month — jurisdictions across the country will have to look to Quebec as the rest of the country decides whether to follow the province’s lead.
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rest → announce → lead
“If they want to do it, they must come to Quebec first.
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they → want → Quebec
They must question the Quebec ministry on what are the drawbacks and problems they have encountered to not reproduce them,” said Rivard, a family physician who now works in palliative care.
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who → question → care
“And if the Quebec ministry tells them that there’s no problem with advance requests for MAID, then they are bullsh—-ing them.”
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they → tell → them
The province’s advance request law came into effect in the fall of 2024, and the Trudeau government chose not to challenge it.
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government → come → it
While provinces and territories oversee the administration of MAID, the federal government is responsible for legal considerations under the Criminal Code.
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government → oversee → Code
Justice Minister Sean Fraser said the Carney government will introduce legislation later this fall to allow physicians to draft and honour advance requests under “a set of circumstances” that have yet to be made public.
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that → say → circumstances
“We do expect this is going to start a conversation at a provincial level about how they may extend services across Canada, with the full knowledge that the doctors who provide the services will not be treated as criminals for doing so.
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who → expect → criminals
This will be a conversation I expect that will play out in Canada over the next number of years,” Fraser said.
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Fraser → expect → years
Since Quebec’s law came into force, 3,463 advance requests have been filed in the province.
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requests → come → province
Quebec’s Health Ministry told the Star that it was not possible to confirm how many people have actually received MAID through that pathway; those numbers and other findings tied to the practice will be released later this fall in a report from the province’s commission on end-of-life care.
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numbers → tell → care
Boisvert estimates that 30 to 40 advance requests have been fulfilled, while Moreau believes the numbers are closer to 20 to 30.
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numbers → estimate → 30
How the process works
A mentally competent patient with an incurable diagnosis initiates an advance request with a medical professional, and files it with the province’s health insurance board.
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patient → work → board
The patient details the clinical manifestations they must be exhibiting to trigger the procedure.
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they → detail → procedure
The most common manifestations, which must be recurring, include no longer recognizing loved ones; needing assistance with hygiene or mobility; becoming aggressive or dangerous to others; and experiencing physical pain that cannot be controlled.
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that → recur → pain
The patient can then select one or two trusted third parties — typically family members — to oversee their case.
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patient → select → case
Once the patient has significantly declined, Boisvert says, phase two of the process begins.
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phase → decline → process
The trusted parties ask the physician to evaluate the patient and decide whether it is appropriate to provide MAID.
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it → trust → MAID
The physician and a second medical professional must assess the patient and determine that they are experiencing “enduring and unbearable physical or psychological suffering” that cannot be relieved.
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that → assess → suffering
For Boisvert, this is where the weaknesses lie in Quebec’s law.
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weaknesses → lie → law
He recalls the only time that he recommended against carrying out the procedure under an advance request.
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he → recall → request
“It was a very old woman … and she met some of the manifestations that were in the advance request,” said Boisvert, who is also the president of the Association québécoise pour le droit de mourir dans la dignité, a Quebec right-to-die group.
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who → meet → dignité
When he evaluated her, she seemed to be in good spirits and reported no pain, although she didn’t know where she was.
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she → evaluate → pain
Boisvert told the woman’s trusted party that while she met some of the criteria she had outlined in her request, he felt the patient wasn’t suffering.
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patient → tell → request
The third party agreed with his assessment, and decided to re-evaluate the woman at a later point.
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party → agree → point
A Parliamentary report by MP Marcus Powlowski “is an extremely thoughtful contribution by
But what would Boisvert have done if the third party disagreed with his recommendation?
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party → do → recommendation
What if two third parties disagreed with each other?
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parties → disagree → other
And how was he to truly know if his patient was suffering if she was too incapacitated for rational conversation?
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she → know → conversation
“That’s the big conundrum we have,” he told the Star.
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he → ’ → Star
“Does meeting the clinical manifestations mean I’m suffering, or do I have to demonstrate suffering when I’m incapacitated?
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I → meet → suffering
That’s the big problem that is not resolved in Quebec.”
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that → ’ → Quebec
Consent for sedation
Moreau, a palliative care doctor, says Canada should also look at the Netherlands, where advance requests have been legally recognized since 2002.
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requests → say → 2002
…and 41 more, not listed.
The Aporia
