Medical Assistance in Dying (MAiD)

Aide médicale à mourir (AMM)

General Overview

  • Identify what is important
  • Explore, inform of alternative options (including palliative care), support
  • Assure that you will continue to provide care they want
  • Clarify that wishes can change at any time
  • Refer if required

Federal Eligibility for MAiD

  • Insured under Health Insurance Act
  • 18 years of age and capable of making decisions with respect to their health;
  • Grievous and irremediable medical condition;
    • Serious and incurable illness, disease or disability;
    • Advanced state of irreversible decline in capability;
    • As a result, they suffer enduring physical or psychological suffering that is intolerable to them and that cannot be relieved under conditions that they consider acceptable;
    • Their natural death has become reasonably foreseeable, taking into account all of their medical circumstances, without a prognosis necessarily having been made as to the specific length of time that they have remaining.
  • Voluntary request for medical assistance in dying that was not made as a result of external pressure;
  • Informed consent to receive medical assistance in dying after having been informed of the means that are available to relieve their suffering, including palliative care

MAiD Process

Request of information

  • First contact with health professional (may be physician)
    • Explore motives of the MAiD request
    • Provide information on
      • Illness
      • Medical diagnosis
      • Life expectancy (prognososis)
      • Possible alternative treatment options including curative and palliative
    • Discuss criteria for MAiD
      • Assess capacity to consent to care

Request for MAiD

  • Patient must sign form in front of health professional and countersigned by health professional (MD, RN, SW, PT/OT, Psychotherapist)
    • Two witnesses are required
      • Must not be a beneficiary or part of the patient's health care team or establishment

Treating physician must be notified (if not yet)

  • Medical decision by first physician must be made
    • Explore motives of the MAiD request, provide information (including palliative care) once again
    • Assess criteria for MAiD
    • Discussion with interdisciplinary team, patient, family


  • May ask for GIS (Groupe interdisciplinaire de soutien)
    • Team includes physician, nurse, ethicist, spiritual services, social worker, coordinator, psychologist
    • Guides throughout the steps of MAiD
    • Useful in difficult cases


  • If physician has conscientious objections, must communicate to DSP to refer to another physician
  • If the physician has no conscientious objections
    • Explain they are allowed to change their mind at any moment, even before injection
    • Patient must repeatedly state their desire for MAiD over multiple visits within a "reasonable" interval
  • Must have independent second opinion from another physician

Non-admissible Request by First or Second physician

  • Inform the patient of the refusal and the reasons for refusal
  • Consider GIS
  • Ensure that the patient is aware about recourse for "Commissaire local aux plaintes"
  • Ensure that the patient is aware they they may submit another request

Admissible Request

  • Determine location (eg. home, hospital)
  • Determine moment
  • Determine who the patient would want with them
  • Contact pharmacist, discuss when to pick-up medication and protocol
  • Discuss organ donation or tissue donation (referral to organ donation organization)

Pharmacological Considerations

  • Good IV access is an absolute prerequisite
    • Consider central line if poor peripheral access
  • Step 1: Anxiolysis
    • Midazolam 2.5-10mg IV over 2 minutes
  • Step 2: Artificial Coma Induction
    • Lidocaine 2% (without epinephrine) 2mL IV over 30 seconds (or magnesium sulfate if allergy to lidocaine)
    • Propofol 1000mg IV over 5 minutes (or phenobarbital if allergy to propofol)
    • Coma confirmed prior to step 3
  • Step 3: Neuromuscular blocker injection
    • NS 0.9% 10mL IV flush
    • Cisatracurium 30mg rapid IV injection (or rocuronium)
    • Repeat flush

Declaration of MAiD

  • Death certificate (note: MAiD is NOT a cause of death)
  • Send all documentation to CMDP/CMQ and Commission sur les soins en fin de vie