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As passed 5 June, 2014 [Original]
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LEGISLATION AMENDED BY THIS bill :
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LEGISLATION AMENDED BY THIS bill :
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Act respecting end-of-life care
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- Civil Code of Québec;
- Code of Civil Procedure (chapter C-25);
- Medical Act (chapter M-9);
- Act respecting health services and
social services (chapter S-4.2).
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- Civil Code of Québec;
- Code of Civil Procedure (chapter C-25);
- Medical Act (chapter M-9);
- Pharmacy Act
(chapter P-10);
- Act respecting health services and social
services (chapter S-4.2).
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TITLE I
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TITLE I
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TITLE I
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PURPOSE OF ACT
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1. The purpose of this Act is to ensure that
end-of-life patients are provided care that is respectful of their
dignity and their autonomy. The Act establishes the rights of such
patients as well as the organization of and a framework for end-of-life
care so that everyone may have access, throughout the continuum of care,
to quality care that is appropriate to their needs, including prevention
and relief of suffering.
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1. The purpose of this Act is to ensure that
end-of-life patients are provided care that is respectful of their
dignity and their autonomy. The Act establishes the rights of such
patients as well as the organization of and a framework for end-of-life
care so that everyone may have access, throughout the continuum of care,
to quality care that is appropriate to their needs, including prevention
and relief of suffering.
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1. The purpose of this Act is to ensure that
end-of-life patients are provided care that is respectful of their
dignity and their autonomy. The Act establishes the rights of such
patients as well as the organization of and a framework for end-of-life
care, including medical aid in dying, so that everyone may have access, throughout the continuum of care,
to quality care that is appropriate to their needs, including prevention
and relief of suffering.
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In addition, this Act allows the exercise of some of those rights by patients who are not at the end of life so that they receive end-of-life care in cases where their condition requires it.
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In addition, the Act recognizes the primacy of
freely and clearly expressed wishes with respect to care, in particular
by establishing an advance medical directives regime.
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In addition, the Act recognizes the primacy of
freely and clearly expressed wishes with respect to care, in particular
by establishing an advance medical directives regime.
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Lastly, the Act recognizes the primacy of
freely and clearly expressed wishes with respect to care, in particular
by establishing an advance medical directives regime.
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TITLE II
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TITLE II
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TITLE II
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END-OF-LIFE CARE
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END-OF-LIFE CARE
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END-OF-LIFE CARE
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CHAPTER I
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CHAPTER I
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CHAPTER I
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GENERAL PROVISIONS
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GENERAL PROVISIONS
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GENERAL PROVISIONS
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2. The provision of end-of-life care is to be guided
by the following principles:
(1) respect for end-of-life patients and
recognition of their rights and freedoms must inspire every act
performed in their regard;
(2) end-of-life patients must be treated, at all
times, with understanding, compassion, courtesy and fairness, and with
respect for their dignity, autonomy, needs and safety; and
(3) the healthcare team providing care to
end-of-life patients must establish and maintain open and transparent
communication with them.
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2. The provision of end-of-life care is to be guided
by the following principles:
(1) respect for end-of-lifepatients and
recognition of their rights and freedoms must inspire every act
performed in their regard;
(2) end-of-life patients must be treated, at all
times, with understanding, compassion, courtesy and fairness, and with
respect for their dignity, autonomy, needs and safety; and
(3) the healthcare team providing care to
end-of-life patients must establish and maintain open and transparent
communication with them.
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2. The provision of end-of-life care is to be guided
by the following principles:
(1) respect for patients and
recognition of their rights and freedoms must inspire every act
performed in their regard;
(2) patients must be treated, at all
times, with understanding, compassion, courtesy and fairness, and with
respect for their dignity, autonomy, needs and safety; and
(3) the healthcare team providing care to
patients must establish and maintain open and transparent
communication with them.
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3. For the purposes of this Act, (1) "institution" means any institution governed by
the Act respecting health services and social services (chapter
S-4.2) that operates a local community service centre, a hospital centre
or a residential and long-term care centre, as well as the Cree Board of
Health and Social Services of James Bay established under the Act
respecting health services and social services for Cree Native persons
(chapter S-5);
(2) "palliative care hospice"
means a community organization that holds an accreditation granted by
the Minister under the second paragraph of section 457 of the Act
respecting health services and social services and has entered into an
agreement with an institution under section 108.3 of that Act in order
to secure all or some of the care required by its
end-of-life patients;
(3)"end-of-life care" means palliative care
provided to persons at the end of their
lives, including terminal palliative sedation, and medical
aid in dying.
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3. For the purposes of this Act,
(1) "institution" means any institution governed by
the Act respecting health services and social services (chapter
S-4.2) that operates a local community service centre, a hospital centre
or a residential and long-term care centre, as well as the Cree Board of
Health and Social Services of James Bay established under the Act
respecting health services and social services for Cree Native persons
(chapter S-5);
(2) "palliative care hospice"
means a community organization that holds an accreditation granted by
the Minister under the second paragraph of section 457 of the Act
respecting health services and social services and has entered into an
agreement with an institution under section 108.3 of that Act in order
to secure all or some of the care required by its
users;
(3) "end-of-life care" means
palliative care provided to end-of-life
patients and medical aid in dying;
(4)
"palliative care" means the
total and active care delivered by an interdisciplinary team to patients
suffering from a disease with reserved prognosis, in order to relieve
their suffering, without delaying or hastening
death, maintain the
best quality of life possible and provide them and their close relations
the support they need;
(5)
"continuous palliative sedation"
means care that is offered as part of palliative care and consists in
administering medications or substances to an end-of-life patient to
relieve their suffering by rendering them unconscious without
interruption until death ensues; and
(6)
"medical aid in dying" means
care consisting in the administration by a physician of medications or
substances to an end-of-life patient, at the patient's request, in order
to relieve their suffering by hastening death.
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3. For the purposes of this Act,
(1) "institution" means any institution governed by
the Act respecting health services and social services (chapter
S-4.2) that operates a local community service centre, a hospital centre
or a residential and long-term care centre, as well as the Cree Board of
Health and Social Services of James Bay established under the Act
respecting health services and social services for Cree Native persons
(chapter S-5);
(2) "palliative care hospice"
means a community organization that holds an accreditation granted by
the Minister under the second paragraph of section 457 of the Act
respecting health services and social services and has entered into an
agreement with an institution under section 108.3 of that Act in order
to secure all or some of the care required by its
users;
(3) "end-of-life care" means
palliative care provided to end-of-life
patients and medical aid in dying;
(4)
"palliative care" means the
total and active care delivered by an interdisciplinary team to patients
suffering from a disease with reserved prognosis, in order to relieve
their suffering, without delaying or hastening
death, maintain the
best quality of life possible and provide them and their close relations
the support they need;
(5)
"continuous palliative sedation"
means care that is offered as part of palliative care and consists in administering medications or substances to an end-of-life patient to relieve their suffering by rendering them unconscious without interruption until death ensues; and
(6)
"medical aid in dying" means
care consisting in the administration by a competent professional of medications or
substances to a patient, at the patient's request, in order
to relieve their suffering by hastening death.
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CHAPTER II
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CHAPTER II
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CHAPTER II
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RIGHTS WITH RESPECT TO END-OF-LIFE CARE
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RIGHTS WITH RESPECT TO END-OF-LIFE CARE
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RIGHTS WITH RESPECT TO END-OF-LIFE CARE
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5. Every person whose condition requires it has
the right to receive end-of-life care, subject to the specific
requirements established by this Act.
Such care may be
provided to the person in a facility maintained by an institution, in a
palliative care hospice or at home.
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4. Every person whose condition requires it has the
right to receive end-of-life care, subject to the specific requirements
established by this Act.
Such care is
provided to the person in a facility maintained by an institution, in a
palliative care hospice or at home.
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4. Every person whose condition requires it has the
right to receive end-of-life care, subject to the specific requirements
established by this Act.
Such care is provided to the person in a facility maintained by an institution, in a palliative care hospice or at home. Medical aid in dying may be administered in another place so as to ensure respect for the person's dignity and autonomy as well as the importance of such care, provided the place is authorized beforehand by the director of professional services of the local authority referred to in section 99.4 of the Act respecting health services and social services (chapter S-4.2) that serves the territory in which the place is situated.
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4. This section applies within the
framework of the legislative and regulatory provisions relating to
the organizational and operational structure of institutions and the
policy directions, policies and approaches of palliative care
hospices and within the limits of the human, material and financial
resources at their disposal.
This chapter
complements the provisions of the Civil Code with respect to care
and the provisions of the Act respecting health services and social
services and of the Act respecting health services and social
services for Cree Native persons with respect
to the rights of users
and beneficiaries.
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This section applies within the framework of the
legislative and regulatory provisions relating to the organizational and
operational structure of institutions and the policy directions,
policies and approaches of palliative care hospices and within the
limits of the human, material and financial resources at their
disposal.
It complements
the provisions of the Act respecting health services and social services
and of the Act respecting health services and social services for Cree
Native persons that relate to the rights of users and beneficiaries.
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This section applies within the framework of the
legislative and regulatory provisions relating to the organizational and
operational structure of institutions and the policy directions,
policies and approaches of palliative care hospices and within the
limits of the human, material and financial resources at their
disposal.
It complements
the provisions of the Act respecting health services and social services
(chapter S-4.2) and of the Act respecting health services and social services for Cree
Native persons (chapter S-5) that relate to the rights of users and beneficiaries.
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6. Except as otherwise provided by law, a person
of full age who is capable of consenting
to care may, at any time,
refuse to receive, or withdraw consent to,
a life-sustaining treatment or procedure;
the refusal or
withdrawal may be expressed by any means.
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5. Except as otherwise provided by law, a person of
full age who is capable of giving consent to
care may, at any time, refuse to receive
life-sustaining care or withdraw
consent to such care.
To the extent provided by the
Civil Code, a minor of 14 years of age or over, and in the case of a
minor or a person of full age who is incapable of giving consent, the
person who may give consent to care on their behalf may also make such a
decision.
The refusal of care or withdrawal of
consent to care may be expressed by any means. |
5. Except as otherwise provided by law, a person of
full age who is capable of giving consent to
care may, at any time, refuse to receive
life-sustaining care or withdraw
consent to such care.
To the extent provided by the
Civil Code, a minor of 14 years of age or over, and in the case of a
minor or a person of full age who is incapable of giving consent, the
person who may give consent to care on their behalf may also make such a
decision.
The refusal of care or withdrawal of
consent to care may be expressed by any means. |
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The physician must
ensure that such a decision is made freely and provide the person
with all information needed to make an informed decision, in particular
information about other therapeutic possibilities, including palliative
care.
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The physician must make
sure that such a decision is made freely and provide the person
with all information needed to make an informed decision, in particular
information about other therapeutic possibilities, including palliative
care.
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The competent professsional must make
sure that such a decision is made freely and provide the person
with all information needed to make an informed decision, in particular
information about other therapeutic possibilities, including palliative
care.
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7. A person may not be denied end-of-life care for
previously having refused to receive a
treatment or procedure or having withdrawn consent to
a treatment or procedure.
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6. A person may not be denied end-of-life care for
previously having refused to receive certain
care or having withdrawn consent to
certain care. |
6. A person may not be denied end-of-life care for
previously having refused to receive certain
care or having withdrawn consent to
certain care.
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CHAPTER III
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CHAPTER III
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CHAPTER III
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ORGANIZATION OF END-OF-LIFE CARE
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ORGANIZATION OF END-OF-LIFE CARE
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ORGANIZATION OF END-OF-LIFE CARE
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DIVISION I
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DIVISION I
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DIVISION I
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SPECIAL RULES APPLICABLE TO PROVIDERS OF END-OF-LIFE CARE
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SPECIAL RULES APPLICABLE TO PROVIDERS OF END-OF-LIFE CARE
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SPECIAL RULES APPLICABLE TO PROVIDERS OF END-OF-LIFE CARE
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§1. - Institutions
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§1. - Institutions
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§1. - Institutions
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8. Every institution must offer end-of-life care and
ensure that it is provided to the persons requiring it in continuity
and complementarity with any other care that is or has been provided to
them.
For this purpose, an institution must, among other things,
establish measures to promote
multidisciplinary cooperation among the different health or social
services professionals practising within the institution.
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7. Every institution must offer end-of-life care and
ensure that it is provided to the persons requiring it in continuity and
complementarity with any other care that is or has been provided to
them.
For this purpose, an institution must, among
other things, establish measures to promote a
multiple-discipline approach by health and social services professionals
and the collaboration of the various other resources concerned who
provide services to its users.
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7. Every institution must offer end-of-life care and
ensure that it is provided to the persons requiring it in continuity and
complementarity with any other care that is or has been provided to
them.
For this purpose, an institution must, among
other things, establish measures to promote a
multiple-discipline approach by health and social services professionals
and the collaboration of the various other resources concerned who
provide services to its users.
If the institution is a public institution, it must establish an interdisciplinary group composed of experts whose functions are to support and accompany, on request, the health or social services professionals or the other resources concerned who take part in the end-of-life care provided. Such a group supports and accompanies, on request, any professional or other resource concerned practising or exercising their functions in a centre operated by a private institution or in a palliative care hospice.
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10. Every institution must adopt a policy with
respect to end-of-life care. The policy must be consistent with
ministerial policy directions and be madeknown to the personnel of the
institution, to the health and social services professionals who
practise in the institution, and to end-of-life patients and their close
relations.
The executive director of the institution must
report annually to the board of directors on the
implementation of
the policy. The report must state the number of end-of-life patients who
received palliative care, the number of
terminal palliative sedations administered,
the number of
requests for medical aid in dying, the number of times such aid was
administered and
the number of times
such requests were refused,
including
the reasons for the refusals.
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8. Every institution must adopt a policy with
respect to end-of-life care. The policy must be consistent with
ministerial policy directions and be made known to the personnel of the
institution, to the health and social services professionals who
practise in the institution, and to end-of-life patients and their close
relations.
The executive director of the institution must
report annually to the board of directors on the
carrying out of the policy. The report
must include the number of end-of-life
patients who received palliative care, the number of
times continuous palliative sedation was
administered, the number of requests for medical aid in dying,
the number of times such aid was administered
as well as the number of times medical aid in dying
was not administered,
including the reasons
it was not administered.
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8. Every institution must adopt a policy with
respect to end-of-life care. The policy must be consistent with
ministerial policy directions and be made known to the personnel of the
institution, to the health and social services professionals who
practise in the institution, and to end-of-life patients and their close
relations.
The executive director of the institution must
report annually to the board of directors on the
carrying out of the policy. The report
must include the number of end-of-life
patients who received palliative care, the number of
times continuous palliative sedation was
administered, the number of requests for medical aid in dying,
the number of times such aid was administered
as well as the number of times medical aid in dying
was not administered,
including the reasons
it was not administered.
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The report must also state, where applicable,
the number of terminal palliative
sedations administered and the
number of times medical aid in dying was administered in the premises of
a palliative care hospice under agreement with the institution as well
as the number of times such aid was administered by a physician
practising in a private health facility with which the institution is
associated in accordance with section 17.
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The report must also state, where applicable, the
number of times continuous palliative sedation and medical aid in
dying were administered at the patient's home
or in the premises of a
palliative care hospice by a physician as a physician practising in a
centre operated by the institution.
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The report must also state, where applicable, the
number of times continuous
palliative sedation and medical aid in
dying were administered at the patient's home
or in the premises of a
palliative care hospice by a competent professional as a physician practising in a
centre operated by the institution.
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The report must list the information set out in the second and third paragraphs according to the type of competent professional concerned. |
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The institution must include a summary of the
report in a separate section of its annual management report.
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The report is to be published on the website of the institution and
sent, not later than 30 June each year, to the Commission sur les soins
de fin de vie established under section 38. The institution must
include a summary of the report in a separate section of its annual
management report.
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The report is to be published on the website of the institution and
sent, not later than 30 June each year, to the Commission sur les soins
de fin de vie established under section 38. The institution must
include a summary of the report in a separate section of its annual
management report.
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9. Every institution must include a clinical program
for end-of-life care in its organization plan. In the case of a local
authority referred to in section 99.4 of the Act respecting health
services and social services, the plan must also include in-home care
for end-of-life patients.
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9. Every institution must include a clinical program
for end-of-life care in its organization plan.
In the case of an institution that operates a local community service
centre, the plan must also include the provision of end-of-life care at
the patient's home. The organization plan must be consistent with
ministerial policy directions. The clinical program for end-of-life care
is to be sent to the Commission
sur les soins de fin de vie.
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9. Every institution must include a clinical program
for end-of-life care in its organization plan.
In the case of an institution that operates a local community service
centre, the plan must also include the provision of end-of-life care at
the patient's home. The organization plan must be consistent with
ministerial policy directions. The clinical program for end-of-life care
is to be sent to the Commission
sur les soins de fin de vie.
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11. Every institution must
include, in the code of ethics adopted under section 233 of the
Act respecting health services and social services,
a section pertaining specifically to the
rights of end-of-life patients.
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10. The code of ethics
adopted by an institution under section 233 of the Act
respecting health services and social services
must have due respect for the rights of end-of-life patients.
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10. The code of ethics
adopted by an institution under section 233 of the Act
respecting health services and social services
(chapter S-4.2) must have due respect for
the rights of patients with respect to end-of-life care.
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12. When an end-of-life patient requests in-home
palliative care from an institution, but the person's condition or
environment is such that proper care could not be provided at home, the
institution must offer to admit the person to its facilities or direct
them to another institution or to a palliative care hospice that can
meet their needs.
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11. When an end-of-life patient requests in-home
palliative care from an institution, but the person's condition or
environment is such that proper care could not be provided at home, the
institution must offer to admit the person to its facilities or direct
them to another institution or to a palliative care hospice that can
meet their needs.
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11. When an end-of-life patient requests in-home
palliative care from an institution, but the person's condition or
environment is such that proper care could not be provided at home, the
institution must offer to admit the person to its facilities or direct
them to another institution or to a palliative care hospice that can
meet their needs.
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13. An institution must offer a private room to
every patient who is receiving end-of-life care in its facilities
and whose death is imminent.
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12. An institution must offer every patient
receiving end-of-life care a private room
for the final few days preceding the patient's death.
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12. An institution must offer every patient receiving end-of-life care a private room for the final few days preceding the patient's death.
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§2. - Palliative care hospices
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§ 2. - Palliative care hospices
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§ 2. - Palliative care hospices
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14. End-of-life care may
be offered in the premises of a palliative care hospice.
Every palliative care hospice must inform
persons of the end-of-life care it offers before admitting them.
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13. Palliative care hospices
determine the end-of-life care provided
in their premises.
Every palliative care hospice must inform
persons of the end-of-life care it offers before admitting them.
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13. Palliative care hospices
determine the end-of-life care provided
in their premises.
Every palliative care hospice must inform
persons of the end-of-life care it offers before admitting them.
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15. A palliative care hospice and an institution
must specify in their agreement under section 108.3 of the Act
respecting health services and social services the nature of the
services the institution is to provide in the premises of the hospice
and the monitoring mechanisms that will allow the institution, or one of
its boards, councils or committees determined in the agreement, to
ensure that quality care is provided in the hospice.
On the request of the institution, the
palliative care hospice must communicate any information required for
the carrying out of the agreement. The manner in which such information
is to be communicated is specified in the agreement.
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14. A palliative care hospice and an institution
must specify in their agreement under section 108.3 of the Act
respecting health services and social services the nature of the
services the institution is to provide in the premises of the hospice
and the monitoring mechanisms that will allow the institution, or one of
its boards, councils or committees determined in the agreement, to
ensure that quality care is provided in the hospice.
On the request of the institution, the
palliative care hospice must communicate any information required for
the carrying out of the agreement. The manner in which such information
is to be communicated is specified in the agreement.
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14. A palliative care hospice and an institution
must specify in their agreement under section 108.3 of the Act
respecting health services and social services (Chapter S-4.2) the nature of the
services the institution is to provide in the premises of the hospice
and the monitoring mechanisms that will allow the institution, or one of
its boards, councils or committees determined in the agreement, to
ensure that quality care is provided in the hospice.
On the request of the institution, the
palliative care hospice must communicate any information required for
the carrying out of the agreement. The manner in which such information
is to be communicated is specified in the agreement.
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16. Every palliative care hospice must adopt a code
of ethics with respect to the rights of end-of-life patients and adopt a
policy with respect to end-of-life care.
These documents must be made known to the
personnel of the palliative care hospice, to the health and social
services professionals who practise in the hospice, and to end-of-life
patients and their close relations.
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15. Every palliative care hospice must adopt a code
of ethics with respect to the rights of end-of-life patients and adopt a
policy with respect to end-of-life care.
These documents must be made known to the
personnel of the palliative care hospice, to the health and social
services professionals who practise in the hospice, and to end-of-life
patients and their close relations.
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15. Every palliative care hospice must adopt a code
of ethics with respect to the rights of end-of-life patients and adopt a
policy with respect to end-of-life care.
These documents must be made known to the
personnel of the palliative care hospice, to the health and social
services professionals who practise in the hospice, and to end-of-life
patients and their close relations.
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§3. - Private health facilities
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§3. - Private health facilities
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§3. - Private health facilities
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17. End-of-life care may be provided at the
patient's home by physicians and, within the
scope of their practice, nurses who practise in a private health
facility within the meaning of section 95 of the Act respecting health
services and social services.
However, such a physician
may not provide terminal palliative sedation or medical aid in dying
otherwise than in association with the local authority of the territory
where the facility is situated.
The terms of the association
must be set out in a written agreement. The agreement must include the
monitoring mechanisms that will allow the local authority, or one of its
boards, councils or committees determined in the agreement, to ensure
that quality care is provided.
On the request of the local
authority, the physician must communicate any information required for
the carrying out of the agreement. The manner in which such information
is to be communicated is specified in the agreement.
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16. End-of-life care may be provided at the
patient's home by physicians practising in a
private health facility within the meaning of section 95 of the Act
respecting health services and social services and, within their scope
of practice, by nurses practising in such a facility.
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16. End-of-life care may be provided at the
patient's home by physicians practising in a
private health facility within the meaning of section 95 of the Act
respecting health services and social services (Chapter S-4.2) and, within their scope
of practice, by nurses practising in such a facility.
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DIVISION II
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DIVISION II
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DIVISION II
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SPECIAL FUNCTIONS OF HEALTH AND SOCIAL SERVICES AGENCIES
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SPECIAL FUNCTIONS OF HEALTH AND SOCIAL SERVICES AGENCIES
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SPECIAL FUNCTIONS OF HEALTH AND SOCIAL SERVICES AGENCIES
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18. Every health and social services agency
must determine the general rules
governing access to the end-of-life care provided by the institutions
and palliative care hospices in its territory.
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17. Every health and social services agency
must, after consultation with the institutions
and palliative care hospices in its territory, determine the
general rules governing access to the end-of-life care provided by those
institutions and hospices.
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17. Every health and social services agency
must, after consultation with the institutions
and palliative care hospices in its territory, determine the
general rules governing access to the end-of-life care provided by those
institutions and hospices.
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19. Every agency must inform the population living
in its territory of the end-of-life care services available and the
manner of accessing them, as well as the rights and options of
end-of-life patients.
This information must be available on the
websites of the agencies.
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18. Every agency must inform the population living
in its territory of the end-of-life care services available and the
manner of accessing them, as well as the rights and options of
end-of-life patients.
This information must be available on the
websites of the agencies.
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18. Every agency must inform the population living
in its territory of the end-of-life care services available and the
manner of accessing them, as well as the rights and options of
end-of-life patients.
This information must be available on the
websites of the agencies.
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DIVISION III
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DIVISION III
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DIVISION III
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SPECIAL FUNCTIONS AND POWERS OF THE MINISTER
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20. The Minister determines the policy directions
that are to guide institutions and agencies when organizing
end-of-life care, including those institutions must take into account
when formulating their end-of-life care policy.
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19. The Minister determines the policy directions
that are to guide institutions and agencies when organizing
end-of-life care, including those which institutions must take into
account when formulating their end-of-life care policy.
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19. The Minister determines the policy directions
that are to guide institutions and agencies when organizing
end-of-life care, including those which institutions must take into
account when formulating their end-of-life care policy.
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21. The Minister may require of institutions
and agencies that they supply, in the
manner and within the time specified, statements, statistical data,
reports and other information required for the performance of
the Minister's functions,
provided
it is not possible to link that information to any specific patient
having received end-of-life care.
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20. The Minister may require of institutions,
palliative care hospices and agencies that
they supply, in the manner and within the time specified,
statements, statistical data, reports and other information required for
the performance of the functions vested in the
Minister under this Act, provided it is not possible to link that
information to any specific patient having received end-of-life care
or to any specific health or social services
professional having provided the care.
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20. The Minister may require of institutions,
palliative care hospices and agencies that
they supply, in the manner and within the time specified,
statements, statistical data, reports and other information required for
the performance of the functions vested in the
Minister under this Act, provided it is not possible to link that
information to any specific patient having received end-of-life care
or to any specific health or social services
professional having provided the care.
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22. In order to ascertain compliance with this
Title, a person authorized in writing by the Minister to carry out an
inspection may, at any reasonable time, enter any premises operated by
an institution or a palliative care hospice.
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21. In order to ascertain compliance with this
Title, a person authorized in writing by the Minister to carry out an
inspection may, at any reasonable time, with due respect for the specific character of the premises and the
needs of the
persons receiving end-of-life care,enter any premises operated
by an institution or a palliative care hospice.
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21. In order to ascertain compliance with this
Title, a person authorized in writing by the Minister to carry out an
inspection may, at any reasonable time, with due respect for the specific character of the premises and the
needs of the
persons receiving end-of-life care, enter any premises operated
by an institution or a palliative care hospice.
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The person may, during an inspection,
(1) examine and make a copy of any document
relating to the end-of-life care offered in those premises; and
(2) demand any information relating to the
carrying out of this Title as well as the production of any related
document.
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The person may, during an inspection,
(1) examine and make a copy of any document
relating to the end-of-life care offered in those premises; and
(2) demand any information relating to the
carrying out of this Title as well as the production of any related
document.
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The person may, during an inspection,
(1) examine and make a copy of any document
relating to the end-of-life care offered in premises referred to in the first paragraph or any document relating to the promotion or advertising of a good or service referred to in section 50.2 or relating to an amount referred to in that section; and
(2) demand any information relating to the
carrying out of this Title as well as the production of any related
document.
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Any person having custody, possession or control
of such documents must make them available on request to the person
conducting the inspection.
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Any person having custody, possession or control
of such documents must make them available on request to the person
conducting the inspection.
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Any person having custody, possession or control
of such documents must make them available on request to the person
conducting the inspection.
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A person conducting an inspection must, if so
required, produce a certificate of capacity.
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A person conducting an inspection must, if so
required, produce a certificate of capacity.
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A person conducting an inspection must, if so
required, produce a certificate of capacity.
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Any person who hinders a person in the conduct
of an inspection, refuses to provide any information or document the
latter is entitled to require or examine, or conceals or destroys any
document or other object relevant to an inspection is guilty of an
offence and is liable to a fine of $2,500 to $25,000 in the case of a
natural person and to a fine of $7,500 to $75,000 in any other case.
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Any person who hinders a person in the conduct
of an inspection, refuses to provide any information or document the
latter is entitled to require or examine, or conceals or destroys any
document or other object relevant to an inspection is guilty of an
offence and is liable to a fine of $2,500 to $25,000 in the case of a
natural person and to a fine of $7,500 to $75,000 in any other case.
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Any person who hinders a person in the conduct
of an inspection, refuses to provide any information or document the
latter is entitled to require or examine, or conceals or destroys any
document or other object relevant to an inspection is guilty of an
offence and is liable to a fine of $2,500 to $25,000 in the case of a
natural person and to a fine of $7,500 to $75,000 in any other case.
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23. The Minister may delegate the powers provided
for in section 22 to a health and social services agency.
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22. The Minister may delegate the powers provided
for in section 21 to a health and social services agency.
The agency informs the Minister of the
designation of an inspector and of the results of the inspection.
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22. The Minister may delegate the powers provided
for in section 21 to a health and social services agency.
The agency informs the Minister of the
designation of an inspector and of the results of the inspection.
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24. A person authorized in writing by the Minister
or, where applicable, by an agency to carry out an inspection may not be
prosecuted for an omission or an act done in good faith in the
performance of their duties.
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23. A person authorized in writing by the Minister
or, where applicable, by an agency to carry out an inspection may not be
prosecuted for an omission or an act done in good faith in the
performance of their duties.
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23. A person authorized in writing by the Minister
or, where applicable, by an agency to carry out an inspection may not be
prosecuted for an omission or an act done in good faith in the
performance of their duties.
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CHAPTER IV
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CHAPTER IV
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CHAPTER IV
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SPECIAL REQUIREMENTS FOR CERTAIN END-OF-LIFE CARE
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SPECIAL REQUIREMENTS FOR CERTAIN END-OF-LIFE CARE
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SPECIAL REQUIREMENTS FOR CERTAIN END-OF-LIFE CARE
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DIVISION I
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DIVISION I
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DIVISION I
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TERMINAL PALLIATIVE SEDATION
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CONTINUOUS PALLIATIVE SEDATION
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CONTINUOUS PALLIATIVE SEDATION
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25. Before giving consent to terminal palliative
sedation, a patient who wishes to receive such sedation
or, where
applicable, the individual authorized to consent to care on behalf of the patient,
must among other things be informed of the prognosis, the
irreversible and terminal
nature of the sedation and the anticipated
duration of the sedation. Consent to terminal
palliative sedation
must be in writing and filed in the patient's record.
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24. Before giving consent to
continuous palliative
sedation, an end-of-life patient or, where applicable, the person who
may give consent to care on behalf of the patient must among other things be
informed of the prognosis for the illness, the irreversible nature of
the sedation and the anticipated duration of the sedation.
In addition, the physician must make sure that the request is being
made freely, in particular by ascertaining that it is not being made
as a result of external pressure.
Consent to continuouspalliative sedation must be given in writing
on the form prescribed by the Minister and be filed in the patient's
record.
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24. Before giving consent to
continuous palliative sedation, an end-of-life patient or, where applicable, the person who
may give consent to care on behalf of the patient must among other things be
informed of the prognosis for the illness, the irreversible nature of
the sedation and the anticipated duration of the sedation.
In addition, the physician must make sure that the request is being
made freely, in particular by ascertaining that it is not being made
as a result of external pressure.
Consent to continuous palliative sedation must be given in writing
on
the form prescribed by the Minister and be filed in the patient's
record.
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25. If the patient giving consent to continuous palliative sedation
cannot date and sign the form referred to in section 24 because the
patient cannot write or is physically incapable of doing so, a third
person may do so in the patient's presence. The third person may not
be a member of the team responsible for caring for the patient, a
minor or a person of full age incapable of giving consent.
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25. If the patient giving consent to continuous palliative sedation
cannot date and sign the form referred to in section 24 because the
patient cannot write or is physically incapable of doing so, a third
person may do so in the patient's presence. The third person may not
be a member of the team responsible for caring for the patient, a
minor or a person of full age incapable of giving consent.
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DIVISION II
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DIVISION II
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DIVISION II
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MEDICAL AID IN DYING
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Not in force
§ - Request for medical aid in dying
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Not in force
25.1. A request for medical aid in dying must be made before such aid can be obtained. Such a request is called a "contemporaneous request for medical aid in dying" or "contemporaneous request" where it is made with a view to an administration of such aid that is contemporaneous to the request. It is called an "advance request for medical aid in dying" or "advance request" where it is made in anticipation of a person becoming incapable of giving consent to care, with a view to an administration of such aid after the onset of that incapacity.
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Not in force
§ - Special provisions applicable to contemporaneous requests for medical aid in dying.
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26. Only a patient who meets the following criteria may obtain
medical aid in dying: |
26. Only a patient who meets
all of the following criteria may obtain
medical aid in dying:
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26. In order to obtain medical aid in dying, a patient must, in addition to making a request that complies with this section and, where applicable, section 27, meet the following criteria:
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1) be of full age, be capable of giving consent to care and be an
insured person within the meaning of the Health Insurance Act
(chapter A-29);
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(2) be of full age and capable of giving consent to care;
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(1) be of full age and capable of giving consent to care, subject to the exception provided for in the third paragraph of section 29 with regard to the patient's capacity;
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(1) be an insured person within the meaning of the Health Insurance
Act (chapter A-29);
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(2) be an insured person within the meaning of the Health Insurance
Act (chapter A-29);
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(3) be at the end of life;
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(3) suffer from a serious and incurable illness and be in an advanced state of irreversible decline in capability, and
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(2) suffer from an incurable serious illness;
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(4) suffer from a serious and incurable illness;
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(3) suffer from
an advanced state of irreversible decline in
capability; and
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(5) be in an advanced state of irreversible decline in capability;
and
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(4) suffer from
constant and unbearable physical or psychological
pain which cannot be relieved in a manner the
person deems tolerable.
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(6) experience constant and unbearable physical or psychological
suffering which cannot be relieved in a manner the patient deems tolerable.
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(4) experience enduring and unbearable physical or psychological suffering that cannot be relieved under conditions the patient considers tolerable.
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For the purposes of subparagraph 2 of the first paragraph, a person with respect to whom the cost of the insured health services they receive or may receive is assumed otherwise than under the Health Insurance Act due to their detention in Québec or due to the fact that they are resident in Québec and in active service in the Canadian Armed Forces is considered an insured person within the meaning of that Act.
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For the purposes of subparagraph 3 of the first paragraph, a mental disorder other than a neurocognitive disorder cannot be an illness for which a person may make a request.
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The patient must request medical aid in dying themselves, in a free
and informed manner, by means of the form prescribed by the Minister.
The form must be dated and signed by the patient
or, if the patient
is physically incapable of doing so, by a third person. The third
person may not be a minor or an incapable person of full age or a
member of the team responsible for caring for the patient.
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The patient must request medical aid in dying themselves, in a free
and informed manner, by means of the form prescribed by the Minister.
The form must be dated and signed by the patient.
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The patient must request medical aid in dying themselves, in a free
and informed manner, by means of the form prescribed by the Minister.
The form must be dated and signed by the patient.
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The form must be signed in the presence of a health or social
services professional who countersigns it; if the professional
countersigning is not the attending physician, the signed form is
given to the attending physician.
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The form must be signed in the presence of and countersigned by a
health or social services professional; if the professional is not
the attending physician, the signed form is to be given by the
professional to the attending physician.
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The form must be signed in the presence of and countersigned by a health or social services professional; the professional who is not the competent professional treating the patient must forward the signed form to the competent professional.
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27.
If the patient requesting medical aid in dying cannot date and sign the
form referred to in section 26 because the patient cannot write or is
physically incapable of doing so, a third person may do so in the
patient's presence. The third person may not be a member of the team
responsible for caring for the patient, a minor or a person of full age
incapable of giving consent.
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27.
If the patient requesting medical aid in dying cannot date and sign the
form referred to in section 26 because the patient cannot write or is
physically incapable of doing so, a third person may do so in the
patient's presence. The third person may not be a member of the team
responsible for caring for the patient, a minor or a person of full age
incapable of giving consent.
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27. A patient may, at any time
and by any means, withdraw their request for medical aid in dying.
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28. A patient may, at any time and by any means,
withdraw their request for medical aid in dying.
A patient may also, at any time and by any means,
request that the administration of medical aid in dying be put off.
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28. A patient may, at any time and by any means,
withdraw their request for medical aid in dying.
A patient may also, at any time and by any means,
request that the administration of medical aid in dying be put off.
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28. Before administering medical
aid in dying, the physician must
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29. Before administering medical aid in dying, the physician must
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29. Before administering medical aid in dying, the
competent professional must
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(1) be of the opinion that the patient meets the
criteria of section 26, after, among other things,
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(1) be of the opinion that the patient meets
all the criteria of section 26, after,
among other things,
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(1) be of the opinion that the patient meets
all the criteria of section 26, after,
among other things,
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(a) making sure that the
request is being made freely and
without any external pressure;
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(a) making sure that the request
is being made freely, in particular by
ascertaining that it is not being made as a result of external
pressure;
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(a) making sure that the request
is being made freely, in particular by
ascertaining that it is not being made as a result of external
pressure;
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(b) making sure that the
request is an informed one, in particular by informing the patient of
the prognostic
and of other therapeutic possibilities and their
consequences;
(c) verifying the persistence
of suffering and that the wish to obtain medical aid in dying remains
unchanged, by talking to
the patient at reasonably spaced intervals given
progress of the patient's condition;
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(b) making sure that the request
is an informed one, in particular by informing the patient of the
prognosis for the illness and of other
therapeutic possibilities and their consequences;
(c) verifying the persistence of
suffering and that the wish to obtain medical aid in dying remains
unchanged, by talking with the patient
at reasonably spaced intervals given the
progress of the patient's condition;
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(b) making sure that the request
is an informed one, in particular by informing the patient of the
prognosis for the illness and of other
therapeutic possibilities and their consequences;
(c) verifying the persistence of
suffering and that the wish to obtain medical aid in dying remains
unchanged, by talking with the patient
at reasonably spaced intervals given the
progress of the patient's condition;
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(d) discussing the patient's request with any
members of the care team who are in regular contact with the patient;
and
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(d) discussing the patient's
request with any members of the care team who are in regular contact
with the patient; and
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(d) discussing the patient's
request with any members of the care team who are in regular contact
with the patient; and
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(e) discussing the patient's request with the
patient's close relations, if the patient so wishes;
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(e) discussing the patient's
request with the patient's close relations, if the patient so wishes;
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(e) if the patient so wishes, discussing the request with the patient's close relations or with any other person the patient identifies;
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(2) make sure that the patient has had the opportunity
to discuss the request with the persons they wished to contact; and
(3) obtain the opinion of a second physician confirming
that the criteria set out in section 26 have been met.
The physician consulted must be independent of both the
patient requesting
medical aid in dying and the physician seeking the
second medical opinion.
The physician consulted must consult the
patient's record, examine the patient
and provide the opinion in
writing.
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(2) make sure that the patient has had the
opportunity to discuss the request with the persons they wished to
contact; and
(3) obtain the opinion of a second physician confirming that the criteria set out in section 26 have been met.
The physician consulted must be independent of both the patient
requesting
medical aid in dying and the physician seeking the second
medical opinion. The physician consulted must consult the patient's
record, examine the patient
and provide the opinion in writing.
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(2) make sure that the patient has had the
opportunity to discuss the request with the persons they wished to
contact; and
(3) obtain the opinion of a second competent professional confirming that the criteria set out in section 26 have been met.
The professional consulted must be independent of both the patient requesting medical aid in dying and the professional seeking the opinion. The professional consulted must consult the patient's record, examine the patient and provide the opinion in writing.
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If an end-of-life patient has become incapable of giving consent to care after making the request, the competent professional may nonetheless administer medical aid in dying to the patient, provided that, at the time the patient was at the end of life and before they became incapable of giving consent to care, |
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(1) all the conditions prescribed in the first paragraph had been met; and
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(2) the patient had given consent, in writing by means of the form prescribed by the Minister and in the presence of a competent professional, and within 90 days before the date of administration of the medical aid in dying, to receiving the aid even if they were to become incapable of giving consent to care before the administration of the aid.
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Any refusal to receive medical aid in dying expressed by a patient referred to in the preceding paragraph must be respected and it is prohibited to disregard it in any manner. |
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Not in force
§3. Special provisions applicable to advance requests for medical aid in dying
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Not in force
I. - Criteria for obtaining medical aid in dying
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Not in force
29.1. In order to obtain medical aid in dying following an advance request, a patient must, in addition to making a request that complies with sections 29.2, 29.3 and 29.7 to 29.10, meet the following criteria:
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(1) at the time the patient makes the request:
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(a) be of full age and capable of giving consent to care;
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(b) be an insured person within the meaning of the Health Insurance Act (chapter A-29); and
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(c) suffer from a serious and incurable illness leading to incapacity to give consent to care; and
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(2) at the time medical aid in dying is to be administered:
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(a) be incapable of giving consent to care due to their illness;
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(b) still meet the criteria set out in subparagraphs b and c of subparagraph 1;
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(c) be exhibiting, on a recurring basis, the clinical manifestations related to their illness that they described in the request; and
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(d) be in a medical state
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i. of advanced, irreversible decline in capability, and
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ii. that gives a competent professional cause to believe, based on the information at their disposal and according to their clinical judgment, that the patient is experiencing enduring and unbearable physical or psychological suffering that cannot be relieved under conditions considered tolerable.
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For the purposes of subparagraph b of subparagraph 1 of the first paragraph, a person with respect to whom the cost of the insured health services they receive or may receive is assumed otherwise than under the Health Insurance Act due to their detention in Québec or due to the fact that they are resident in Québec and in active service in the Canadian Armed Forces is considered an insured person within the meaning of that Act.
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For the purposes of subparagraph c of subparagraph 1 of the first paragraph, a mental disorder other than a neurocognitive disorder cannot be an illness for which a person may make a request.
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Not in force
II. Criteria and other provisions relating to making an advance request
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Not in force
29.2 The patient must make the advance request for themselves, in a free and informed manner, and record it on the form prescribed by the Minister. The form must be dated and signed by the patient.
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If the patient making the request cannot record it on that form or date and sign the form because they cannot write or are physically incapable of doing so, a third person may do so in the patient's presence.
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The third person may not be a member of the care team responsible for the patient and may not be a minor or a person of full age incapable of giving consent.
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Not in force
29.3 A patient making an advance request must be assisted by a competent professional.
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With the assistance of the professional, the patient must describe in detail in the request the clinical manifestations related to their illness that, when the patient has become incapable of giving consent to care and a competent professional finds that they are exhibiting those manifestations, must be considered to be the expression of their consent to medical aid in dying being administered to them once all the criteria set out in this Act have been met.
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The professional must ensure that the clinical manifestations described in the request meet the following criteria:
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(1) be medically recognized as being clinical manifestations that can be related to the illness from which the patient suffers; and
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(2) be observable by a competent professional who would have to observe those manifestations before administering medical aid in dying.
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Not in force
29.4 The competent professional providing assistance to the patient must
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(1) be of the opinion that the patient meets the criteria set out in subparagraph 1 of the first paragraph of section 29.1 and that the request is being made in accordance with section 29.2, after, among other things,
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(a) making sure that the request is being made freely, in particular by ascertaining that it is not being made as a result of external pressure;
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(b) making sure that the request is an informed one, in particular by ascertaining that the patient has clearly understood the nature of the diagnosis and by informing the patient of the anticipated course of and the prognosis for the illness and of the therapeutic possibilities and their consequences;
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(c) discussing the patient's request with any members of the care team who are in regular contact with the patient; and
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(d) if the patient so wishes, discussing the request with the patient's close relations or with any other person the patient identifies; and
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(2) make sure that the patient has had the opportunity to discuss the request with the persons the patient wished to contact.
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Not in force
29.5 The competent professional providing assistance to the patient must notify them that the advance request, made in compliance with this Act, will not automatically lead to the administration of medical aid in dying. For that purpose, the competent professional must, in particular, inform the patient of the following:
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(1) an eventual finding that they are exhibiting, on a recurring basis, the clinical manifestations related to their illness that are described in the request will not by itself suffice to allow medical aid in dying to be administered;
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(2) the aid may be administered to them only if two competent professionals are of the opinion that both of the following criteria have been met:
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(a) the patient's medical state gives those professionals cause to believe, based on the information at their disposal and according to their clinical judgment, that the patient is experiencing enduring and unbearable physical or psychological suffering that cannot be relieved under conditions considered tolerable; and
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(b) the patient meets all the other criteria set out in subparagraph 2 of the first paragraph of section 29.1; and
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(3) the possibility of withdrawing or modifying the advance request and the applicable terms and conditions for the withdrawal or modification.
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The competent professional must be sure to provide the information required under subparagraphs 1 to 3 of the first paragraph in a manner that is clear and accessible to the patient.
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Not in force
29.6 The patient may designate in the advance request a trusted third person to whom they entrust the following responsibilities:
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(1) notify a health or social services professional who provides care to the patient due to their illness where the trusted third person believes
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(a) the patient is exhibiting the clinical manifestations related to their illness that are described in the request; or
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(b) the patient is experiencing enduring and unbearable physical or psychological suffering; and
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(2) when the patient has become incapable of giving consent to care, notify any health or social services professional who provides care to the patient due to their illness of the existence of the request, or remind such a professional of its existence.
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The patient may also designate in the request a second trusted third person who, if the first trusted third person is deceased or is prevented from acting, in particular due to their incapacity, or refuses or neglects to do so, replaces that third person.
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A trusted third person may not be a minor or a person of full age incapable of giving consent.
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Not in force
29.7 After the form has been signed by the person making the advance request or, where applicable, by the third person referred to in the second paragraph of section 29.2, the competent professional providing assistance to the patient dates and countersigns the form to attest compliance with sections 29.3 to 29.5.
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A trusted third person who consents to being designated affixes their signature on the form and dates it.
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Not in force
29.8 The advance request must be made by notarial act en minute or in the presence of witnesses by means of the form referred to in section 29.2.
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If the request is made by notarial act en minute, the duly completed form must be annexed to the notarial act.
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If the advance request is made in the presence of witnesses, the patient declares, in the presence of two witnesses, that the form contains the patient's advance request, without having to disclose the contents.
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The witnesses date and countersign the form.
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No such witness may be a minor or a person of full age incapable of giving consent. Nor may they be designated as a trusted third person in the request or act as a competent professional for the purpose of administering medical aid in dying to the patient.
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Not in force
29.9 All signatories of the advance request form must be in each other's presence when they affix their signature. A signatory may, however, be present remotely where the technological means used for that purpose allows all signatories to be identified, heard and seen in real time.
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Not in force
29.10 Every advance request must, to be applicable, be recorded by the competent professional who provides assistance to the patient making the request or, where applicable, by the officiating notary in the register kept by the Minister in accordance with subparagraph 5 of the second paragraph of section 521 of the Act respecting health services and social services (chapter S-4.2).
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Not in force
III. -Withdrawal and modification of an advance request
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Not in force
29.11 A patient who is capable of giving consent to care may, at any time, withdraw their advance request by means of the form prescribed by the Minister. The second and third paragraphs of section 29.2 apply, with the necessary modifications, to the withdrawal form for such a request.
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A patient who wishes to withdraw their request must be assisted by a competent professional. After the form has been signed, the competent professional dates and countersigns the form to attest that the patient is capable of giving consent to care. The professional must make sure that the request is removed, as soon as possible, from the register referred to in section 29.10.
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A patient may modify an advance request only by making a new advance request by one of the methods specified in section 29.8. The new advance request replaces the previous one as soon as it is recorded in the register in accordance with section 29.10.
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Not in force
IV- Processing of an advance request
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Not in force
29.12 A health or social services professional who provides care to a patient having obtained a diagnosis for a serious and incurable illness leading to incapacity to give consent to care must, when the professional becomes aware of that incapacity, consult the register referred to in section 29.10.
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If the register contains an advance request made by the patient, the professional consults the request and files it in the patient's record, unless the request is already in the record. Furthermore, the professional must ensure that every trusted third person designated in the request has been notified of the onset of the patient's incapacity.
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The professional also informs the health or social services professionals who are members of the care team responsible for the patient of the existence of the request.
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Not in force
29.13 A patient having made an advance request must undergo an examination by a competent professional when the trusted third person notifies a health or social services professional that they believe, as applicable,
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(1) that the patient is exhibiting the clinical manifestations related to their illness that are described in the request; or
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(2) that the patient is experiencing enduring and unbearable physical or psychological suffering.
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The health or social services professional must inform a competent professional of the reception of a notice from the trusted third person.
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The purpose of the examination carried out by the competent professional is to determine whether the patient is exhibiting, on a recurring basis, the clinical manifestations referred to in subparagraph 1 of the first paragraph and whether the patient's medical state gives cause to believe, based on the information at the professional's disposal and according to their clinical judgment, that the patient is experiencing enduring and unbearable physical or psychological suffering that cannot be relieved under conditions considered tolerable.
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Not in force
29.14 If every trusted third person designated in an advance request is deceased or is prevented from acting or refuses or neglects to do so, the patient having made the request must undergo the examination prescribed in the third paragraph of section 29.13 where a competent professional, as applicable,
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(1) finds, at first glance,
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(a) that the patient is exhibiting some of the clinical manifestations related to their illness that are described in the request; or
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(b) that the patient's medical state gives cause to believe that the patient is experiencing enduring and unbearable physical or psychological suffering; or
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(2) is notified by a person that they believe the patient is exhibiting the clinical manifestations referred to in subparagraph a of subparagraph 1 or that the patient is experiencing enduring and unbearable physical or psychological suffering.
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A competent professional must, before carrying out the examination, take reasonable measures to notify every trusted third person designated in the request of the situation.
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Not in force
29.15 The first paragraph of section 29.14 applies, with the necessary modifications, to a patient who did not designate a trusted third person in the advance request.
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Not in force
29.16 If every trusted third person designated in an advance request is deceased or prevented from acting or refuses or neglects to do so, or if no trusted third person was designated in such a request, a health or social services professional who is a member of the care team responsible for the patient having made an advance request must notify a competent professional if the health or social services professional believes that the patient is exhibiting the clinical manifestations related to their illness that are described in the request or that the patient is experiencing enduring and unbearable physical or psychological suffering.
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Not in force
29.17 The competent professional must, as part of an examination required by section 29.13, 29.14 or 29.15, have a discussion, where applicable, with the trusted third person and with the members of the care team responsible for the patient.
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The professional records in writing the clinical manifestations related to the patient’s illness that the professional has observed, the other relevant information in connection with the patient’s medical state and the conclusions of the examination. |
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Not in force
29.18 After carrying out the examination required by section 29.13, 29.14 or 29.15, the competent professional must inform the patient who made the advance request, the members of the care team responsible for the patient and, where applicable, every trusted third person designated in the request of the professional's conclusions.
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The professional must ensure that the process for administering medical aid in dying continues only where the professional concludes that the patient is exhibiting, on a recurring basis, the clinical manifestations related to their illness that they described in the request, and that the patient's medical state gives cause to believe, based on the information at the professional's disposal and according to their clinical judgment, that the patient is experiencing enduring and unbearable physical or psychological suffering that cannot be relieved under conditions considered tolerable.
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Not in force
29.19 Before administering medical aid in dying following an advance request, the competent professional must
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(1) be of the opinion that the patient meets all the criteria set out in subparagraph 2 of the first paragraph of section 29.1 and the first paragraph of section 29.2; and
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(2) obtain the opinion of a second competent professional confirming that the criteria that must be the subject of an opinion under subparagraph 1 have been met.
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The second paragraph of section 29 applies to the professional consulted.
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Any refusal to receive medical aid in dying expressed by the patient must be respected and it is prohibited to disregard it in any manner.
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If the patient is exhibiting behavioural symptoms resulting from their medical state, such as resistance to care, the competent professional must, based on the information at their disposal and according to their clinical judgment, rule out the possibility that the patient is refusing to receive medical aid in dying. The professional must record in writing the symptoms that the professional has observed and the conclusions of the assessment.
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§4 -
Administration of medical aid in dying |
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29. If a physician determines,
subsequent to the application of section 28, that medical aid in dying
may be administered to a patient requesting it, the physician must
administer such aid personally and take care of
the patient until their death.
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30. If a physician determines, subsequent to the
application of section 29, that medical aid in dying may be administered
to a patient requesting it, the physician must administer such aid
personally and take care of and stay with the
patient until death ensues.
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30. If a competent professional determines, subsequent to the
application of section 29, that medical aid in dying may be administered
to a patient requesting it, the professional must administer such aid
personally and take care of and stay with the
patient until death ensues.
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If the physician determines that medical aid in dying
cannot be administered, the physician must inform the patient of the
reasons for that decision.
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If the physician determines that medical aid in dying cannot be
administered, the physician must inform the patient of the reasons for
that decision.
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If the professional concludes, however, subsequent to the application of that section, that medical aid in dying cannot be administered, the physician must inform the patient of the reasons for that decision and of the other services that can be offered to the patient to relieve their suffering.
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Not in force
In the case of an advance request, the professional must also inform any trusted third person designated in the request and any health or social services professional who is a member of the care team responsible for the patient of the conclusion. Where the professional concludes that medical aid in dying may be administered, the professional must inform them before proceeding to administer such aid.
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Not in force
30.1 An advance request does not lapse because a competent professional has concluded that medical aid in dying cannot be administered, unless that conclusion results from the refusal expressed by the patient to receive such aid.
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Not in force
30.2 Where a competent professional concludes that medical aid in dying cannot be administered to a patient having made an advance request due to the refusal expressed by the patient to receive such aid, the professional must make sure that the request is removed, as soon as possible, from the register referred to in section 29.10.
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30. A physician practising in a centre operated by
an institution who refuses a request for medical aid in dying for a
reason not based on section 28 must as soon as possible notify the
director of professional services
or any other person designated by
the executive director of the institution and forward the request
form given to the physician, if such
is the case, to the director of
professional services or designated person. The
director of professional
services or designated person must then take the necessary steps to find
another physician willing to deal with the request in accordance with
section 28.
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31. A physician practising in a centre operated by
an institution who refuses a request for medical aid in dying for a
reason not based on section 29 must, as soon as possible, notify the
executive director
of the institution or any other person designated by the executive
director and forward the request form given to the physician, if
that is the case, to the
executive director or designated person.
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31. Any competent professional must notify the executive director of the institution, or any other person designated by the executive director, and, where applicable, send the executive director or the designated person the medical aid in dying request form in the following cases:
(1) the professional refuses a request for a reason not based on section 29;
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Not in force
(2) the professional refuses to provide assistance to a patient in making an advance request under section 29.3 or in withdrawing such a request under section 29.11; or
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Not in force
(3) the professional refuses to carry out the examination required by section 29.13, 29.14 or 29.15.
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The executive director of the institution or designated person must then
take the necessary steps to find, as soon as possible,
another physician
willing to deal with the request in accordance with section 29.
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The executive director of the institution or designated person must then take the necessary steps to find, as soon as possible, a competent professional willing to remedy the situation. |
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If the physician who receives the request practises in a private
health facility and is not associated with a local authority for the
administration of medical aid in dying, the physician must as soon as
possible notify the director of professional services or any other
person designated by the executive director of the local authority,
and forward the request form given to the physician, if such is the
case, to the director of professional services or designated person.
The steps mentioned in the first paragraph must then be taken.
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If the physician who receives the request practises in a private
health facility and does not provide medical aid in dying, the physician must, as soon as possible, notify the
executive director of
the local authority referred to in section 99.4 of the Act respecting
health services and social services that serves the territory in
which the patient making the request resides, or notify the person
designated by the executive director.
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A competent professional practising in a private health facility must instead forward the notice of refusal to the
executive director of
the local authority referred to in section 99.4 of the Act respecting
health services and social services (chapter S-4.2) that serves the territory in
which the patient making the request resides, or notify the person
designated by the executive director.
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The physician forwards the request form received, if that is the case, to the executive director or designated person and the steps mentioned in the first paragraph must
be taken.
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The professional forwards the medical aid in dying request
form received, if that is the case, to the executive director or
designated person. The steps mentioned in the second paragraph must
be taken.
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If no local authority serves the territory in which the patient
resides, the notice referred to in the second paragraph is forwarded
to the executive director of the institution operating a local
community service centre in the territory or the person designated by
the executive director.
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If no local authority serves the territory in which the patient
resides, the notice referred to in the third paragraph is forwarded
to the executive director of the institution operating a local
community service centre in the territory or the person designated by
the executive director.
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31. All information and documents in connection with
a request for medical aid in dying, regardless of whether the
physician administers it or not, including the form used to request
such aid, the reasons for the physician's decision and, where
applicable, the opinion of the physician consulted, must be recorded or
filed in the patient's record.
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32. All information and documents in connection with
a request for medical aid in dying, regardless of whether the physician administers it or not, including the form used to request such aid, the reasons
for the physician's decision and, where applicable, the opinion of
the physician consulted, must be recorded or filed in the patient's
record.
A decision to withdraw a request for medical aid in dying or to put
off the administration of such aid must also be recorded in the
patient's record.
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32. All information and documents in connection with
a request for medical aid in dying, regardless of whether the
competent professional administers it or not, including the form used to request such aid, the reasons
for the competent professional's decision and, where applicable, the opinion of
the competent professional consulted, must be recorded or filed in the patient's
record.
A decision to withdraw a request for medical aid in dying or to put
off the administration of such aid must also be recorded in the
patient's record.
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DIVISION III
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DIVISION III
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DIVISION III
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SPECIAL FUNCTIONS OF THE COUNCIL OF PHYSICIANS, DENTISTS AND
PHARMACISTS
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SPECIAL FUNCTIONS OF THE COUNCIL OF PHYSICIANS, DENTISTS AND
PHARMACISTS
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SPECIAL FUNCTIONS OF THE COUNCIL OF PHYSICIANS, DENTISTS AND
PHARMACISTS
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32. The council of physicians, dentists and pharmacists established
for an institution must, in accordance with the clinical standards
established by the professional orders concerned, adopt clinical
protocols applicable to terminal
palliative sedation and medical aid
in dying.
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33. The council of physicians, dentists and pharmacists established
for an institution must, in collaboration with the council of nurses
of the institution, adopt clinical protocols
for continuous
palliative sedation and medical aid in dying. The protocols must
comply with the clinical standards developed by the professional
orders concerned.
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33. The council of physicians, dentists and pharmacists established
for an institution must, in collaboration with the council of nurses
of the institution, adopt clinical protocols
for continuous
palliative sedation and medical aid in dying. The protocols must
comply with the clinical standards developed by the professional
orders concerned.
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33. A physician who provides terminal palliative sedation or medical
aid in dying must, once it is administered, give notice to
the
council of physicians, dentists and pharmacists of which the
physician is a member, whether it is administered in the facilities
of an institution, in the premises of a palliative care hospice or at
the patient's home; if the physician practises in a private health
facility, the notice is to be given to the council of physicians,
dentists and pharmacists established for the local authority with
which the physician is associated.
The council of physicians, dentists and pharmacists or its competent
committee assesses the quality of the care provided, particularly with
regard to applicable clinical protocols.
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34. A physician who provides
continuous palliative sedation or
medical aid in dying as a physician practising in a centre operated
by an institution must, within 10 days following its administration,
inform the council of physicians, dentists and pharmacists of which
the physician is a member, whether it is administered in the
facilities of an institution, in the premises of a palliative care
hospice or at the patient's home.
The council of physicians, dentists and pharmacists or its competent
committee assesses the quality of the care provided, particularly with
regard to applicable clinical protocols. |
34. A physician who provides
continuous palliative sedation or
medical aid in dying as a physician practising in a centre operated
by an institution must, within 10 days following its administration,
inform the council of physicians, dentists and pharmacists of which
the physician is a member, whether it is administered in the
facilities of an institution, in the premises of a palliative care
hospice or at the patient's home.
The council of physicians, dentists and pharmacists or its competent
committee assesses the quality of the care provided, particularly with
regard to applicable clinical protocols. |
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34. If no council of physicians, dentists and pharmacists is
established for the institution, the head of medical services or the
physician responsible for medical care in the institution, as
applicable, assumes the functions assigned to the council under this
division, and the notice provided for in the first paragraph of
section 33 is sent to that person.
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35. If no council of physicians, dentists and pharmacists is
established for the institution, the head of medical services or the
physician responsible for medical care in the institution, as
applicable, assumes the functions assigned to the council under this
division, and the physician informs that person in accordance with
the first paragraph of section 34.
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35. If no council of physicians, dentists and pharmacists is
established for the institution, the head of medical services or the
physician responsible for medical care in the institution, as
applicable, assumes the functions assigned to the council under this
division, and the physician informs that person in accordance with
the first paragraph of section 34.
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DIVISION IV
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DIVISION IV
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SPECIAL FUNCTIONS OF THE COLLÈGE DES MÉDECINS DU QUÉBEC
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SPECIAL FUNCTIONS OF THE COLLÈGE DES MÉDECINS DU QUÉBEC
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36. Physicians practising in a private health
facility that provides continuous palliative sedation or medical aid
in dying at the patient's home or in the premises of a palliative
care hospice must, within 10 days following its administration,
inform the Collège des médecins du Québec and send to it,
under the conditions and in the manner prescribed by the Collège,
the information it determines.
The Collège or its competent committee assesses the quality of the
care provided, particularly with regard to applicable clinical
standards.
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36. Physicians practising in a private health
facility that provides continuous palliative sedation or medical aid
in dying at the patient's home or in the premises of a palliative
care hospice must, within 10 days following its administration,
inform the Collège des médecins du Québec and send to it,
under the conditions and in the manner prescribed by the Collège,
the information it determines.
The Collège or its competent committee assesses the quality of the
care provided, particularly with regard to applicable clinical
standards.
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37. The Collège des médecins du Québec must prepare a yearly report
on the end-of-life care provided by physicians practising in private
health facilities.
The report must state the number of times
continuous palliative sedation and medical aid in dying were
administered by such physicians at the patient's home or in the
premises of a palliative care hospice. The information must be grouped
by local health and social services network territory and health and
social services agency territory.
The report is to be published on the website of the Collège and sent,
not later than 30 June each year, to the Commission sur les soins de
fin de vie.
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37. The Collège des médecins du Québec must prepare a yearly report
on the end-of-life care provided by physicians practising in private
health facilities.
The report must state the number of times
continuous palliative sedation and medical aid in dying were
administered by such physicians at the patient's home or in the
premises of a palliative care hospice. The information must be grouped
by local health and social services network territory and health and
social services agency territory.
The report is to be published on the website of the Collège and sent,
not later than 30 June each year, to the Commission sur les soins de
fin de vie.
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CHAPTER V
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CHAPTER V
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CHAPTER V
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COMMISSION SUR LES SOINS DE FIN DE VIE
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COMMISSION SUR LES SOINS DE FIN DE VIE
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COMMISSION SUR LES SOINS DE FIN DE VIE
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DIVISION I
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DIVISION I
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DIVISION I
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ESTABLISHMENT AND FUNCTIONING OF THE COMMISSION
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ESTABLISHMENT AND FUNCTIONING OF THE COMMISSION
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ESTABLISHMENT AND FUNCTIONING OF THE COMMISSION
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35. A commission on end-of-life care ("the Commission") is
established under the name "Commission sur les soins de fin de vie".
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38. A commission on end-of-life care ("the Commission") is
established under the name "Commission sur les soins de fin de vie".
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38. A commission on end-of-life care ("the Commission") is
established under the name "Commission sur les soins de fin de vie".
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36. The Commission is composed of
seven members, appointed by the
Government as follows:
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39. The Commission is composed of
11 members, appointed by the
Government as follows:
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39. The Commission is composed of
13 members, appointed by the
Government as follows:
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(1) four
members are to be health or social services professionals,
including at least two physicians, appointed after consultation with
the professional orders concerned;
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(1) five members are to be health or social services professionals,
including
(a) two members appointed after consultation with the Collège des
médecins du Québec;
(b) one member appointed after consultation with the Ordre des
infirmières et infirmiers du Québec;
(c) one member appointed after consultation with the Ordre des
pharmaciens du Québec; and
(d) one member appointed after consultation with the Ordre
professionnel des travailleurs sociaux et des thérapeutes conjugaux
et familiaux du Québec;
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(1) seven members are to be health or social services professionals,
including
(a) three members appointed after consultation with the Collège des
médecins du Québec;
(b) two members appointed after consultation with the Ordre des
infirmières et infirmiers du Québec;
(c) one member appointed after consultation with the Ordre des
pharmaciens du Québec; and
(d) one member appointed after consultation with the Ordre
professionnel des travailleurs sociaux et des thérapeutes conjugaux
et familiaux du Québec;
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(2) one
member is to be a jurist, appointed after consultation with
the professional orders concerned;
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(2) two members are to be jurists, appointed after consultation with
the Barreau du Québec and the Chambre des notaires du Québec;
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(2) two members are to be jurists, appointed after consultation with
the Barreau du Québec and the Chambre des notaires du Québec;
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(3) one
member is to be a user of an institution, appointed after
consultation with bodies representing the users' committees of the
institutions; and
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(3) two members are to be users of institutions, appointed after
consultation with bodies representing the users' committees of
institutions;
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(3) two members are to be users of institutions, appointed after
consultation with bodies representing the users' committees of
institutions;
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(4) one member is to be from the ethics community, appointed after
consultation with university-level teaching
institutions.
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(4) one member is to be from the ethics community, appointed after
consultation with university-level educational institutions; and
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(4) one member is to be from the ethics community, appointed after
consultation with university-level educational institutions; and
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(5) one member is to be appointed after consultation with bodies
representing institutions.
The Government must ensure that at least one member appointed under
subparagraph 1 of the first paragraph is from the palliative care
community.
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(5) one member is to be appointed after consultation with bodies
representing institutions.
The Government must ensure that at least one member appointed under
subparagraph 1 of the first paragraph is from the palliative care
community.
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The members of the Commission are appointed for a term of not more
than five years. Their terms of office may be renewed consecutively
only once. At the expiry of their terms, members remain in office
until they are replaced or re-appointed.
The Government designates, from among the members of the Commission,
a chair and vice-chair; the vice-chair shall chair the Commission when
the chair is absent or unable to act.
The Government fixes the allowances and indemnities of the members of
the Commission.
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The members of the Commission are appointed for a term of not more
than five years. Their terms of office may be renewed consecutively
only once. At the expiry of their terms, members remain in office
until they are replaced or reappointed.
The Government designates, from among the members of the Commission,
a chair and vice-chair; the vice-chair shall chair the Commission when
the chair is absent or unable to act.
The Government fixes the allowances and indemnities of the members of
the Commission.
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The members of the Commission are appointed for a term of not more
than five years. Their terms of office may be renewed consecutively
only once. At the expiry of their terms, members remain in office
until they are replaced or reappointed.
The Government designates, from among the members of the Commission,
a chair and vice-chair; the vice-chair shall chair the Commission when
the chair is absent or unable to act.
The Government fixes the allowances and indemnities of the members of
the Commission.
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37. The Commission may make by-laws concerning its internal
management.
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40. The Commission may make by-laws concerning its
internal management.
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40. The Commission may make by-laws concerning its
internal management.
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38. The quorum at meetings of the Commission is
five members,
including the chair or the vice-chair.
Subject to the second paragraph of section 42, the decisions of the
Commission are made by a majority vote of the members present. In the
case of a tie vote, the person presiding at the meeting has a casting
vote.
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41. The quorum at meetings of the Commission is
seven members, including the chair
or the vice-chair.
Subject to the second paragraph of section 47, the decisions of the
Commission are made by a majority vote of the members present. In the
case of a tie vote, the person presiding at the meeting has a casting
vote.
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41. The quorum at meetings of the Commission is
nine members, including the chair
or the vice-chair.
Subject to the second paragraph of section 47, the decisions of the
Commission are made by a majority vote of the members present. In the
case of a tie vote, the person presiding at the meeting has a casting
vote.
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DIVISION II
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DIVISION II
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DIVISION II
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MANDATE OF THE COMMISSION
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MANDATE OF THE COMMISSION
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MANDATE OF THE COMMISSION
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39. The mandate of the Commission is to examine any matter relating
to end-of-life care. For this purpose, it must, among other things,
(1) advise the Minister on any matter put before it by the Minister;
(2) evaluate the implementation of legislation with regard to
end-of-life care;
(3) refer to the Minister any matter relating to end-of-life care
that needs the attention of or action by the Government, and submit
its recommendations to the Minister;
(4) submit a report to the Minister, every five years, on the status
of endof- life care in Québec; and
(5) carry out any other mandate given to it by the Minister.
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42. The mandate of the Commission is to examine any matter relating
to end-of-life care. For this purpose, it must, among other things,
(1) advise the Minister on any matter put before it by the Minister;
(2) evaluate the implementation of legislation with regard to
end-of-life care;
(3) refer to the Minister any matter relating to end-of-life care
that needs the attention of or action by the Government, and submit
its recommendations to the Minister;
(4) submit a report to the Minister, every five years, on the status
of endof- life care in Québec; and
(5) carry out any other mandate given to it by the Minister.
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42. The mandate of the Commission is to examine any matter relating
to end-of-life care. For this purpose, it must, among other things,
(1) advise the Minister on any matter put before it by the Minister;
(2) evaluate the implementation of legislation with regard to
end-of-life care;
(3) refer to the Minister any matter relating to end-of-life care
that needs the attention of or action by the Government, and submit
its recommendations to the Minister;
(4) submit a report to the Minister, every five years, on the status
of endof- life care in Québec; and
(5) conduct required analyses and produce required statistical information in order, in particular, to follow the evolution of end-of-life care, identify end-of-life care needs and determine what may constitute a limit to access to such care.
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The Commission carries out any other end-of-life care-related mandate given to it by the Minister.
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The Commission also has the mandate of overseeing the application of
the specific requirements relating to medical aid in dying in
compliance with this division.
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The Commission also has the mandate of overseeing the application of
the specific requirements relating to medical aid in dying in
compliance with this division.
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The Commission also has the mandate of overseeing the application of
the specific requirements relating to medical aid in dying in
compliance with this division.
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The Commission submits an annual activity report to the Minister.
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The Commission is to submit an annual activity report, not later than
30 September each year, to the Minister.
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The Commission is to submit an annual activity report, not later than
30 September each year, to the Minister.
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43. The Minister tables the reports produced by the Commission in the
National Assembly within 30 days of receiving them or, if the Assembly
is not sitting, within 30 days of resumption. The competent committee
of the National Assembly examines the reports.
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43. The Minister tables the reports produced by the Commission in the
National Assembly within 30 days of receiving them or, if the Assembly
is not sitting, within 30 days of resumption. The competent committee
of the National Assembly examines the reports.
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40. In exercising its functions under the first paragraph of section
39, the Commission may
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44. In exercising its functions under the first paragraph of section
42, the Commission may, as an exception, take such measures as
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44. In exercising its functions under the first paragraph of section
42, the Commission may take such measures as
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(1) solicit opinions on any matter concerning end-of-life care from
individuals or groups;
(2) conduct or commission studies and research it deems necessary;
and
(3) call on outside experts to report to it on one or more specific
points.
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(1) soliciting the opinion of individuals or groups on any
end-of-life care issue;
(2) conducting or commissioning studies and research it deems
necessary; and
(3) calling on outside experts to report to it on one or more
specific points.
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(1) soliciting the opinion of individuals or groups on any
end-of-life care issue;
(2) conducting or commissioning studies and research it deems
necessary; and
(3) calling on outside experts to report to it on one or more
specific points.
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The Commission may also exercise the powers set out in subparagraphs 1 to 3 of the first paragraph for the purpose of carrying out a mandate given to it by the Minister under the second paragraph of section 42. |
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45. The Commission may require of institutions, palliative care
hospices, physicians practising in a private health facility and
agencies that they supply, in the manner and within the time
specified, the statements, statistical data, reports and other
information it needs for the performance of its functions under the
first paragraph of section 42, provided it is not possible to link that
information to any specific patient having received end-of-life care or
to any specific health or social services professional having
provided the care.
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45. The Commission may require of institutions, palliative care
hospices, competent professionals practising in a private health facility and
agencies that they supply, in the manner and within the time
specified, the statements, statistical data, reports and other
information it needs for the performance of its functions under the
first paragraph of section 42 or to carry out a mandate given to it by the Minister under the second paragraph of that section, provided it is not possible to link that
information to any specific patient having received end-of-life care or
to any specific health or social services professional having
provided the care.
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41. A physician who administers medical aid in dying must give notice
to the Commission within the next 10 days and send the Commission, in
the manner determined by government regulation, the information
prescribed by regulation. This information is confidential and may
not be disclosed to any other person, except to the extent that is
necessary for the purposes of this section and section 42.
A
physician who contravenes this section is guilty of an offence and is
liable to a fine of $1,000 to $10,000.
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46. A physician who administers medical aid in dying must give notice
to the Commission within the next 10 days and send the Commission, in
the manner determined by government regulation, the information
prescribed by regulation. This information is confidential and may
not be disclosed to any other person, except to the extent that is
necessary for the purposes of this section and section 47.
Any
person who notes that a physician has contravened this section must
bring the breach to the attention of the Collège des médecins du Québec
so that it can take appropriate measures.
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46. A physician who administers medical aid in dying must give notice
to the Commission within the next 10 days and send the Commission, in
the manner determined by government regulation, the information
prescribed by regulation. This information is confidential and may
not be disclosed to any other person, except to the extent that is
necessary for the purposes of this section and section 47.
Any
person who notes that a physician has contravened this section must
bring the breach to the attention of the Collège des médecins du Québec
so that it can take appropriate measures.
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42. On receiving the notice from the physician, the Commission assesses
compliance with section 28 in accordance with the procedure prescribed
by government regulation. On completion of the assessment, if
two-thirds or more of the members present are of the opinion that
section 28 was not complied with, the Commission sends a summary of
its conclusions to the physician, to the institution concerned, to
the Collège des médecins du Québec and to any other authority concerned.
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47. On receiving the notice from the physician, the Commission
assesses compliance with section 29 in accordance with the procedure
prescribed by government regulation. On completion of the
assessment, if two thirds or more of the members present are of the
opinion that section 29 was not complied with, the Commission sends a
summary of its conclusions to the Collège des médecins du Québec and,
when the physician provided the medical aid in dying as a physician
practising in a centre operated by an institution, to the institution
concerned so that they can take appropriate measures.
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47. On receiving the notice from the physician, the Commission
assesses compliance with section 29 in accordance with the procedure
prescribed by government regulation. On completion of the
assessment, if two thirds or more of the members present are of the
opinion that section 29 was not complied with, the Commission sends a
summary of its conclusions to the Collège des médecins du Québec and,
when the physician provided the medical aid in dying as a physician
practising in a centre operated by an institution, to the institution
concerned so that they can take appropriate measures.
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47.1 A competent professional having received a request for medical aid in dying who does not administer such aid to the patient having made the request must notify the Commission within 30 days after any of the following events occurs:
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(1) the professional finds that the patient does not meet the criteria set out in section 29;
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(2) the professional finds or is informed that the patient has withdrawn their request;
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(3) the professional finds or is informed that the patient has refused to receive medical aid in dying;
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(4) the professional has forwarded a notice of refusal under section 31; or
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(5) the professional finds or is informed that the patient has died before the administration of medical aid in dying.
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When notifying the Commission, the competent professional must also send it, in the manner determined by government regulation, the information prescribed by that regulation and, where applicable, the information concerning any other service they provided to the patient to relieve their suffering. Such information is confidential and may not be disclosed to any other person, except to the extent that the information is necessary for the purposes of this section.
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47.2 A pharmacist who provides a medication or a substance to a competent professional for the purpose of the administration of medical aid in dying must notify the Commission within 30 days and send it, in the manner determined by government regulation, the information prescribed by that regulation. This information is confidential and may not be disclosed to any other person, except to the extent that the information is necessary for the purposes of this section.
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47.3 In exercising its functions under the first paragraph of section 42, the Commission may use any information sent to it under sections 46, 47.1 and 47.2, provided it is not possible to link that information to any specific patient who made a request for medical aid in dying, to a patient to whom such aid was administered or to a health or social services professional, including a pharmacist referred to in section 47.2.
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The Commission may also, on the same conditions, use such information for the purpose of carrying out a mandate given to it by the Minister under the second paragraph of section 42.
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CHAPTER VI
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CHAPTER VI
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CHAPTER VI
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MISCELLANEOUS PROVISIONS
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MISCELLANEOUS PROVISIONS
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MISCELLANEOUS PROVISIONS
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48. Complaints regarding end-of-life care made by any person to a
local or regional service quality complaints commissioner, in
accordance with the rules prescribed in Divisions I to III of Chapter
III of Title II of the Act respecting health services and social
services, must be given priority treatment. The same applies to
complaints regarding end-of-life care made to the syndic of the
Collège des médecins du Québec.
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48. Complaints regarding end-of-life care made by any person to a
local or regional service quality complaints commissioner, in
accordance with the rules prescribed in Divisions I to III of Chapter
III of Title II of the Act respecting health services and social
services (chapter S-4.2), must be given priority treatment. The same applies to
complaints regarding end-of-life care made to the syndic of the
Collège des médecins du Québec.
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43. A person's decision to refuse to receive a treatment or
procedure, to withdraw consent to a life-sustaining treatment or
procedure or to request
terminal palliative sedation or medical aid
in dying may not be invoked as a reason to refuse to pay a benefit or
any other sum due under a contract.
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49. The decision of a patient or, where applicable, of the person who
may give consent to care on the patient's behalf to refuse certain
life-sustaining care or withdraw consent to such care
or to request continuous
palliative sedation or medical aid in dying may not be
invoked as a reason to refuse to pay a benefit or any other sum due
under a contract.
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49. The decision of a patient or, where applicable, of the person who
may give consent to care on the patient's behalf to refuse certain
life-sustaining care or withdraw consent to such care
or to request continuous
palliative sedation or medical aid in dying may not be
invoked as a reason to refuse to pay a benefit or any other sum due
under a contract.
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44. This Act does not limit the right of health professionals to
refuse, in accordance with their code of ethics, to provide or take
part in providing end-of- life care for reasons of conscience.
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50. A physician may refuse to administer medical aid in dying because
of personal convictions, and a health professional may refuse to take
part in administering it for the same reason. In such a
case, the physician or health professional must nevertheless ensure
that continuity of care is provided to the patient, in accordance with
their code of ethics and the patient's wishes. In addition, the
physician must comply with the procedure established in section 31.
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50. A competent professional may refuse to administer medical aid in dying because
of personal convictions, and a health professional may refuse to take
part in administering it for the same reason. Such professionals must nevertheless ensure
that continuity of care is provided to the patient, in accordance with
their code of ethics and the patient's wishes. In addition, the
physician must comply with the procedure established in section 31.
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50.1 The Minister may, by regulation, determine the form and content of any notices required under this Act as well as the conditions relating to their sending.
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50.2 No one may promote or advertise a good or service supplied in the course of a commercial activity by associating it directly or indirectly with medical aid in dying or charge any amount related directly or indirectly to obtaining such aid.
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The first paragraph does not have the effect of limiting the supply of health services or social services to a person having made a request for medical aid in dying.
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Anyone who contravenes the first paragraph is liable to a fine of $5,000 to $50,000 in the case of a natural person or to a fine of $15,000 to $150,000 in any other case. The amounts of the fines are doubled for a subsequent offence.
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TITLE III
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TITLE III
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TITLE III
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ADVANCE MEDICAL DIRECTIVES
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ADVANCE MEDICAL DIRECTIVES
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ADVANCE MEDICAL DIRECTIVES
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CHAPTER I
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CHAPTER I
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CHAPTER I
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GENERAL PROVISIONS
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GENERAL PROVISIONS
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GENERAL PROVISIONS
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45. A person of full age who is capable of giving consent to care may
specify,in advance medical directives, what care required by their
state of health they consent or do not consent to, in the event that
they become incapable of giving consent.
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51. A person of full age who is capable of giving consent to care
may, by means of advance medical directives, specify whether or not
they consent to care that may be required by their state of health,
in the event they become incapable of giving consent. However, in
such directives the person may not request medical aid in dying.
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51. A person of full age who is capable of giving consent to care
may, by means of advance medical directives, specify whether or not
they consent to care that may be required by their state of health,
in the event they become incapable of giving consent. However, in
such directives the person may not request medical aid in dying.
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In addition to instructions relating to care, the directives may
include the names of one or more trusted persons who are to give
them, at the appropriate time, to the attending physician or to
another health professional providing care to the person.
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46. Advance medical directives are given by notarial act en minute or
in the presence of witnesses on the form prescribed by the Minister.
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52. Advance medical directives are given by notarial act en minute or
in the presence of witnesses on the form prescribed by the Minister.
At the request of their author, advance medical directives are to be
recorded in the advance medical directives register established under
section 63.
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52. Advance medical directives are given by notarial act en minute or
in the presence of witnesses on the form prescribed by the Minister.
At the request of their author, advance medical directives are to be
recorded in the advance medical directives register established under
section 63.
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47. Directives given in the presence of witnesses must be written by
the person themselves or, if the person is physically incapacitated,
by a third person in accordance with the person's instructions.
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53. When advance medical directives are given in the presence of
witnesses, the form must be completed by the person concerned.
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53. When advance medical directives are given in the presence of
witnesses, the form must be completed by the person concerned.
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In the presence of two witnesses, the person declares that the
document is the person's advance medical directives, but need not
disclose the contents. The person dates and signs the directives
at the end or, if this is already done, recognizes the signature as
their own; also, if the person is physically incapacitated, the
directives may be signed by a third person in the person's presence.
The directives are then signed by the witnesses in the presence of
the person and of the third person, where applicable.
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The person then declares, in the presence of two witnesses, that the
form contains the person's advance medical directives, without having
to disclose the contents. The person dates and signs the form or, if
this is already done, recognizes the signature as their own. The form
is then signed by the witnesses in the person's presence.
If the person cannot complete the form because the person cannot
write or is physically incapable of doing so, it may be completed by
a third person in accordance with the person's instructions. The
third person signs and dates the form in the person's presence.
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The person then declares, in the presence of two witnesses, that the
form contains the person's advance medical directives, without having
to disclose the contents. The person dates and signs the form or, if
this is already done, recognizes the signature as their own. The form
is then signed by the witnesses in the person's presence.
If the person cannot complete the form because the person cannot
write or is physically incapable of doing so, it may be completed by
a third person in accordance with the person's instructions. The
third person signs and dates the form in the person's presence.
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An incapable person of full age or a minor may not act as a third
person or a witness for the purposes of this section.
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Persons of full age incapable of giving consent and minors cannot act
as a third person or a witness for the purposes of this section.
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Persons of full age incapable of giving consent and minors cannot act
as a third person or a witness for the purposes of this section.
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48. Advance medical directives may be revoked at any time and by any
means by the person concerned. Such directives may only be changed by
writing new ones by one of the methods specified in section 46. The
new directives replace any previous ones.
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54. Advance medical directives may be revoked at any time by the
person concerned by means of the form prescribed by the Minister.
Such directives may only be changed by writing new ones by one of the
methods specified in the first paragraph of section 52. The new
directives replace any previous ones.
Despite the preceding paragraphs, in emergency cases, if a person
capable of giving consent to care verbally expresses wishes different
from those in their advance medical directives, this entails the
revocation of the directives.
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54. Advance medical directives may be revoked at any time by the
person concerned by means of the form prescribed by the Minister.
Such directives may only be changed by writing new ones by one of the
methods specified in the first paragraph of section 52. The new
directives replace any previous ones.
Despite the first and second paragraphs, in emergency cases, if a person
capable of giving consent to care verbally expresses wishes different
from those in their advance medical directives, this entails the
revocation of the directives.
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49. When advance medical directives are given to a health
professional, that professional records them in the advance medical
directives register established under section 57 and files them in
the record of the person concerned. If the directives are given to
the health professional by the person concerned and the person is
capable of giving consent to care, the health professional must first
inquire whether they still correspond to the person's wishes.
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55. When advance medical directives are given to a health
professional, that professional files them in the record of the
person concerned if this has not yet been done. If the directives are
given to the health professional by the person concerned and the
person is capable of giving consent to care, the health professional
must first inquire whether they still correspond to the person's
wishes.
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55. When advance medical directives are given to a health
professional, that professional files them in the record of the
person concerned if this has not yet been done. If the directives are
given to the health professional by the person concerned and the
person is capable of giving consent to care, the health professional
must first inquire whether they still correspond to the person's
wishes.
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50. A physician who notes a significant change in the condition of a
person capable of giving consent to care must, if advance medical
directives have been filed in the person's record, inquire whether
the directives still correspond to the person's wishes.
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56. A physician who notes a significant change in the state of health
of a person capable of giving consent to care must, if advance
medical directives have been filed in the person's record, inquire
whether the directives still correspond to the person's wishes.
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56. A physician who notes a significant change in the state of health
of a person capable of giving consent to care must, if advance
medical directives have been filed in the person's record, inquire
whether the directives still correspond to the person's wishes.
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51. A physician who notes that a person is incapable of giving
consent to care consults the advance medical directives register. If
the register contains advance medical directives for the person, the
physician files them in the person's record.
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57. A physician who notes that a person is incapable of giving
consent to care consults the advance medical directives register. If
the register contains advance medical directives for the person, the
physician files them in the person's record.
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57. A physician who notes that a person is incapable of giving
consent to care consults the advance medical directives register. If
the register contains advance medical directives for the person, the
physician files them in the person's record.
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52. When a person is incapable of giving consent to care, clearly
expressed instructions relating to care that are recorded in the
advance medical directives register or filed in the person's record
carry, for all health professionals having access to the register or
record, the same weight as wishes expressed by a person capable of
giving consent to care.
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58. When a person is incapable of giving consent to care, clearly
expressed instructions relating to care that are recorded in the
advance medical directives register or filed in the person's record
carry, for all health professionals having access to the register or
record, the same weight as wishes expressed by a person capable of
giving consent to care.
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58. When a person is incapable of giving consent to care, wishes relating to care that are clearly
expressed in advance medical directives recorded in the register referred to in the second paragraph of section 52 or filed in the person's record
carry, for all health professionals having access to the register or
record, the same weight as wishes expressed by a person capable of
giving consent to care.
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53. The author of advance medical directives is presumed to have been
in the possession of the information needed to make an informed
decision at the time of signing the directives.
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59. The author of advance medical directives is presumed to have been
in the possession of the information needed to make an informed
decision at the time of signing the directives.
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59. The author of advance medical directives is presumed to have been
in the possession of the information needed to make an informed
decision at the time of signing the directives.
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54. If a person incapable of giving consent to care categorically
refuses care which they had previously consented to in advance
medical directives, article 16 of the Civil Code, requiring the
authorization of the court, applies.
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60. If a person incapable of giving consent to care categorically
refuses care which they had previously consented to in advance
medical directives, article 16 of the Civil Code, requiring the
authorization of the court, applies.
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60. If a person incapable of giving consent to care categorically
refuses care which they had previously consented to in advance
medical directives, article 16 of the Civil Code, requiring the
authorization of the court, applies.
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55. The court may, on the application of the mandatary, tutor,
curator of or any person showing a special interest in the author of
advance medical directives, order that the instructions relating to
care expressed in those directives be carried out.
The court may also, on the application of such a person, invalidate
advance medical directives, in full or in part, if it has reasonable
grounds to believe that the author of the directives was not capable
of consenting to the care at the time of signing the directives or
that the directives do not correspond to the author's wishes in the
present situation.
The court may, in addition, make any other order it considers
appropriate in the circumstances.
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61. The court may, on the application of the mandatary, tutor,
curator of or any person showing a special interest in the author of
advance medical directives, order that the instructions relating to
care expressed in those directives be carried out.
The court may also, on the application of such a person, a physician
or an institution, invalidate advance medical directives, in full or
in part, if it has reasonable grounds to believe that the author of
the directives was not capable of consenting to the care at the time
of signing the directives or that the directives do not correspond to
the author's wishes in the present situation.
The court may, in addition, make any other order it considers
appropriate in the circumstances.
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61. The court may, on the application of the mandatary, tutor,
curator of or any person showing a special interest in the author of
advance medical directives, order that the instructions relating to
care expressed in those directives be carried out.
The court may also, on the application of such a person, a physician
or an institution,invalidate advance medical directives, in full or
in part, if it has reasonable grounds to believe that the author of
the directives was not capable of consenting to the care at the time
of signing the directives or that the directives do not correspond to
the author's wishes in the present situation.
The court may, in addition, make any other order it considers
appropriate in the circumstances.
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56. Instructions relating to care expressed in a mandate given in
anticipation of a person's incapacity do not constitute advance
medical directives within the meaning of this Act and remain subject
to articles 2166 and following of the Civil Code.
In case of inconsistency between those instructions for care and the
instructions contained in advance medical directives, the latter
prevail.
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62. Instructions relating to care expressed in a mandate given in
anticipation of a person's incapacity do not constitute advance
medical directives within the meaning of this Act and remain subject
to articles 2166 and following of the Civil Code.
In case of inconsistency between those instructions for care and the
instructions contained in advance medical directives, the latter
prevail.
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62. Instructions relating to care expressed in a protection mandate do not constitute advance
medical directives within the meaning of this Act and remain subject
to articles 2166 and following of the Civil Code.
In case of inconsistency between those instructions for care and the
instructions contained in advance medical directives, the latter
prevail.
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CHAPTER II
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CHAPTER II
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CHAPTER II
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ADVANCE MEDICAL DIRECTIVES REGISTER
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ADVANCE MEDICAL DIRECTIVES REGISTER
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ADVANCE MEDICAL DIRECTIVES REGISTER
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57. The Minister establishes and maintains an advance medical
directives register.
The Minister may manage the register or entrust its management to a
body that is subject to the Act respecting Access to documents held
by public bodies and the Protection of personal information (chapter
A-2.1). In the latter case, the Minister enters into a written
agreement with the manager.
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63. The Minister establishes and maintains an advance medical
directives register.
The Minister may manage the register or entrust its management to a
body that is subject to the Act respecting Access to documents held
by public bodies and the Protection of personal information (chapter
A-2.1). In the latter case, the Minister enters into a written
agreement with the manager.
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63. The Minister establishes and maintains an advance medical
directives register.
The Minister may manage the register or entrust its management to a
body that is subject to the Act respecting Access to documents held
by public bodies and the Protection of personal information (chapter
A-2.1). In the latter case, the Minister enters into a written
agreement with the manager.
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58. The Minister prescribes, by regulation, how the register is to be
accessed and operated, including who may record advance medical
directives in the register, in addition to what is provided in
section 49, and who may consult it.
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64. The Minister prescribes, by regulation, how the register is to be
accessed and operated, including who may record advance medical
directives in the register and who may consult it.
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64. The Minister prescribes, by regulation, how the register is to be
accessed and operated, including who may record advance medical
directives in the register and who may consult it.
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TITLE IV
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TITLE IV
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TITLE IV
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AMENDING, TRANSITIONAL AND FINAL PROVISIONS
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AMENDING, TRANSITIONAL AND FINAL PROVISIONS
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AMENDING, TRANSITIONAL AND FINAL PROVISIONS
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CHAPTER I
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CHAPTER I
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CHAPTER I
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AMENDING PROVISIONS
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AMENDING PROVISIONS
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AMENDING PROVISIONS
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CIVIL CODE OF QUEBEC
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CIVIL CODE OF QUEBEC
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CIVIL CODE OF QUEBEC
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59. Article 11 of the Civil Code of Québec is amended
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65. Article 11 of the Civil Code of Québec is amended
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65. (Amendment integrated into the Civil Code, a.11.)
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(1) by adding the following sentence at the end of the first
paragraph:
"Except as otherwise provided by law, the consent is subject to no
other formal requirement and may be withdrawn at any time, even
verbally.";
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(1) by adding the following sentence at the end of the first
paragraph:
"Except as otherwise provided by law, the consent is subject to no
other formal requirement and may be withdrawn at any time, even
verbally.";
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(2) by inserting "and has not drawn up advance medical directives
under the Act respecting end-of-life care (insert the year and
chapter number of this Act) by which he expresses such consent or
refusal" after "care" in the second paragraph.
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(2) by inserting "and has not drawn up advance medical directives
under the Act respecting end-of-life care (insert the year and
chapter number of this Act) by which he expresses such consent or
refusal" after "care" in the second paragraph.
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60. Article 12 of the Code is amended by replacing "taking into
account, as far as possible, any" in the first paragraph by
"complying, as far as possible, with any".
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66. Article 12 of the Code is amended by replacing "taking into
account, as far as possible, any" in the first paragraph by
"complying, as far as possible, with any".
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66. (Amendment integrated into the Civil Code, a.12.)
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61. Article 15 of the Code is amended by inserting "and in the
absence of advance medical directives" after "state of health".
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67. Article 15 of the Code is amended by inserting "and in the
absence of advance medical directives" after "state of health".
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67. (Amendment integrated into the Civil Code, a.15.)
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CODE OF CIVIL PROCEDURE
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CODE OF CIVIL PROCEDURE
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CODE OF CIVIL PROCEDURE
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62. Article 776 of the Code of Civil Procedure (chapter C-25) is
amended by adding the following sentence at the end of the first
paragraph: "The same applies to any application under section 55 of
the Act respecting end-of-life care (insert the year and chapter
number of this Act) concerning the carrying out of advance medical
directives."
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68. Article 776 of the Code of Civil Procedure (chapter C-25) is
amended by adding the following sentence at the end of the first
paragraph: "The same applies to any application under section 61 of
the Act respecting end-of-life care (insert the year and chapter
number of this Act) concerning the carrying out of advance medical
directives."
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68. (Amendment integrated into C-25, a. 776.)
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MEDICAL ACT
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MEDICAL ACT
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63. Section 31 of the Medical Act (chapter M-9) is amended
(1) by replacing the first paragraph by the following paragraph:
"31. The practice of medicine consists in assessing and diagnosing
any health deficiency in a person in interaction with their
environment, in preventing and treating illness to maintain or
restore health or to provide appropriate symptom relief.";
(2) by adding the following subparagraph at the end of the second
paragraph:
"(12) administering the drug or substance allowing an end-of-life
patient to obtain medical aid in dying under the Act respecting
end-of-life care (insert the year and chapter number of this Act)."
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69. Section 31 of the Medical Act (chapter M-9) is amended
(1) by
replacing the first paragraph by the following paragraph:
"31. The
practice of medicine consists in assessing and diagnosing any health
deficiency in a person in interaction with their environment, in
preventing and treating illness to maintain or restore health or to
provide appropriate symptom relief.";
(2) by adding the following subparagraph at the end of the second
paragraph:
"(12) administering the drug or substance allowing an end-of-life
patient to obtain medical aid in dying under the Act respecting
end-of-life care (insert the year and chapter number of this Act)."
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69. (Amendment integrated into c.M-9, s. 31)
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PHARMACY ACT
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PHARMACY ACT
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70. Section 17 of the Pharmacy Act (chapter P‑10), amended by section
2 of chapter 37 of the statutes of 2011, is again amended by
replacing "in order to maintain or restore health" in the first
paragraph by "in order to maintain or restore health or to provide
appropriate symptom relief".
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70. (Amendment integrated into c.P-10, s. 17)
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ACT RESPECTING HEALTH SERVICES AND SOCIAL SERVICES
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ACT RESPECTING HEALTH SERVICES AND SOCIAL SERVICES
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ACT RESPECTING HEALTH SERVICES AND SOCIAL SERVICES
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64. Section 19 of the Act respecting health services and social
services (chapter S-4.2, amended by section 160 of chapter 23 of the
statutes of 2012, is
again amended by adding the following
subparagraph after subparagraph 13:
"(14) in a case where the information is communicated
for the
purposes of the Act respecting end-of-life care (insert the year and
chapter number of this Act)."
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71. Section 19 of the Act respecting health services and social
services (chapter S-4.2) is amended by adding the following
subparagraph after subparagraph 13:
"(14) for the purposes of the Act respecting end-of-life care (insert
the year and chapter number of this Act)."
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71. (Amendment integrated into c.S-4.2, s. 19)
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CHAPTER II
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CHAPTER II
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CHAPTER II
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TRANSITIONAL AND FINAL PROVISIONS
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TRANSITIONAL AND FINAL PROVISIONS
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TRANSITIONAL AND FINAL PROVISIONS
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65. Despite section 8, an institution which, on (insert the date of
coming into force of section 8), operates a general and specialized
hospital centre and, within the range of care that may be offered
pursuant to the mission of such a centre, only offers palliative care
may continue to offer that care exclusively.
Such an institution must
inform persons of the end-of-life care it offers before admitting
them.
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72. Despite section 7, an institution which, on 10 December 2015, operates a general and specialized
hospital centre and, within the range of care that may be offered
pursuant to the mission of such a centre, only offers palliative care
may continue to offer that care exclusively.
Such an institution must inform persons of the end-of-life care it
offers before admitting them.
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72. Despite section 7, an institution which, on (insert the date of
coming into force of section 7), operates a general and specialized
hospital centre and, within the range of care that may be offered
pursuant to the mission of such a centre, only offers palliative care
may continue to offer that care exclusively.
Such an institution must inform persons of the end-of-life care it
offers before admitting them.
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66. Until (insert the date occurring two years after the date of
coming into force of section 10), executive directors of institutions
must report every three
months to their board of directors as
described in the second paragraph of section 10.
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73. Until 10 December 2017, executive directors of institutions
must report every six months to their board of directors as described
in the second paragraph of section 8. The institutions are to forward
the report to the Commission sur les soins de fin de vie as soon as
possible and publish it on their website.
Until that date, the Collège des médecins du Québec is also to send
the Commission the report required under section 37 every six months.
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73. Until 10 December 2017, executive directors of institutions
must report every six months to their board of directors as described
in the second paragraph of section 8. The institutions are to forward
the report to the Commission sur les soins de fin de vie as soon as
possible and publish it on their website.
Until that date, the Collège des médecins du Québec is also to send
the Commission the report required under section 37 every six months.
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67. Institutions and palliative care hospices have until (insert the
date occurring one year after the date of coming into force of
section 15) to amend the agreement they have entered into under
section 108.3 of the Act respecting health services and social
services (chapter S-4.2) in order to bring it into conformity with
section 15.
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74. Institutions and palliative care hospices have until 10 December 2016 to amend the agreement they have entered into under
section 108.3 of the Act respecting health services and social
services (chapter S-4.2) in order to bring it into conformity with
section 14.
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74. Institutions and palliative care hospices have until 10 December 2016 to amend the agreement they have entered into under
section 108.3 of the Act respecting health services and social
services (chapter S-4.2) in order to bring it into conformity with
section 14.
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75. Despite subparagraph 4 of the first paragraph of section 42, the
Commission sur les soins de fin de vie must send its first report on the
status of end-of-life care not later than 10 December 2018.
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75. Despite subparagraph 4 of the first paragraph of section 42, the Commission sur les soins de fin de vie must send its first report on the status of end-of-life care not later than 10 December 2018.
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68. The Minister must, not later than (insert the date occurring five
years after the date of coming into force of this section) and
subsequently every five years, report to the Government on the
carrying out of this Act.
Such report is tabled by the Minister in
the National Assembly within the next 30 days or, if the Assembly is
not sitting, within 30 days of resumption. The report is examined by
the competent committee of the National Assembly.
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76. The Minister must, not later than 10 December 2019, report to
the Government on the implementation of this Act, and subsequently
every five years, report to the Government on the carrying out of
this Act.
Such report is tabled by the Minister in the National Assembly within
the next 30 days or, if the Assembly is not sitting, within 30 days
of resumption. The report is examined by the competent committee of
the National Assembly.
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76. The Minister must, not later than 10 December 2019, report to
the Government on the implementation of this Act, and subsequently
every five years, report to the Government on the carrying out of
this Act.
Such report is tabled by the Minister in the National Assembly within
the next 30 days or, if the Assembly is not sitting, within 30 days
of resumption. The report is examined by the competent committee of
the National Assembly.
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69. The Minister of Health and Social Services is responsible for the
administration of this Act.
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77. The Minister of Health and Social Services is responsible for the
administration of this Act.
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77. The Minister of Health and Social Services is responsible for the
administration of this Act.
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70. The provisions of this Act come into force on the date or dates
to be set by the Government.
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78. Except for the second paragraph of section 52, section 57,
section 58 to the extent that it concerns the advance medical
directives register and sections 63 and 64, which come into force on
the date or dates to be set by the Government, the provisions of this
Act come into force on (insert the date occurring 18 months after the
date of assent to this Act), or any earlier date set by the
Government.
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78. (Omitted)
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