October 30, 2024
On October 30, 2024, new legislation comes into effect in Québec which will allow Québec physicians and specialized nurse practitioners to provide medical assistance in dying (MAID) pursuant to an advance request under certain circumstances. However, no changes have been made at a federal level to the Criminal Code to allow advance requests in Canada.
This presents unique clinical and medico-legal challenges. Through these changes, CMPA is here to support you.
Considering being involved in MAID advance requests? Contact us first
CMPA does not set standards or practices as to how MAID is to be provided. Our immediate priority is to provide proactive support to our members who will be providing this care.
We encourage all physicians who are involved in the provision of MAID pursuant to advance requests to contact us first to receive case-specific advice to assist them in making informed choices in the delivery of end-of-life care to their patients.
We will also provide you with assistance in the event of medico-legal issues arising from the provision of MAID, whether in the context of advance requests or otherwise.
Challenging situation with differing Québec and federal law
The existence of discordant provisions between the federal and Québec statutory framework for MAID adds complexity to the provision of this care. This creates a challenging situation for MAID practitioners in Québec who are required to comply with both Québec’s end-of-life legislation and the Criminal Code when involved in MAID requests. Without amendments to the Criminal Code, and in the absence of a clear protective framework, physicians who provide MAID pursuant to an advance request in Québec could potentially face criminal prosecution, and potentially imprisonment, for violating the Criminal Code.
Québec’s stakeholders taking steps to reduce risk
To address this concern and reduce the risk to MAID practitioners, Québec’s Minister of Justice has modified the ministerial prosecutorial guidelines (Orientations et mesures du ministre de la Justice en matière d’affaires criminelles et pénales available in French only) and the Director of Criminal and Penal Prosecutions issued directives (Instruction du directeur concernant les poursuites criminelles dans le contexte de l’aide médicale à mourir available in French only).
The directives state that it is not in the public interest to authorize the filing of criminal charges or allow private prosecution related to a death following MAID, if MAID was provided in compliance with the person’s free and informed wishes, taking into account Québec’s Act respecting end of life care. Additionally, any consideration of charges will need to be brought to the attention of the Director personally so that the Director can decide whether to pursue the charges.
In a joint statement, the Collège des médecins du Québec (CMQ), the Barreau du Québec and four other professional orders have indicated that discussions will continue toward the harmonization of Québec’s Act respecting end of life care and the federal Criminal Code. Until the legislations are harmonized, great care must be exercised when providing MAID pursuant to advance requests.
CMPA working actively with stakeholders to support you
CMPA is actively working with stakeholders in Québec, including the Ministry of Health, the Ministry of Justice, and the CMQ, to identify and reduce the risk to physicians at a criminal, civil, and regulatory level. We have also reached out to the federal Ministries of Health and Justice and are interested in working with them to address this issue.
Throughout these changes, CMPA will continue to support you with case-specific advice. We will also continue to keep you informed with up-to-date MAID resources and information (updated today) so you can safely and effectively support your patients with end-of-life decisions.
Contact us
- via CMPA’s secure member portal.
- Call us at 1-800-267-6522 Monday to Friday: 8:30 a.m. to 4:30 p.m. ET. Conversations are confidential, empathetic and non-judgmental.
Take care,
Your CMPA
