The Difference Between Medical Aid in Dying (MAiD) and Advance Medical Directives (AMD)

2024-02-15 

You’ve probably heard of Advance Medical Directives (AMD) and Medical Aid in Dying (MAiD) — two topics that are often confused, especially as Québec’s legislation around them continues to evolve.

But what exactly do they mean, and why is it important to understand the difference?

Medical Aid in Dying (MAiD)

MAiD refers to a medical procedure, usually carried out by a physician, in which a patient’s life is intentionally ended at their explicit request, to relieve intolerable suffering. It is legal in Canada, as well as in countries like Belgium, the Netherlands, and some U.S. states (such as Oregon).

The request must be made by a competent person in a terminal phase or suffering from a serious, incurable illness. The person must be capable of giving informed consent, understanding the nature of their illness, the treatments available, and the consequences of choosing MAiD.

Currently in Québec, you cannot request MAiD in advance — only when you're actively suffering and in an end-of-life situation. If, at that moment, a doctor determines you're no longer capable of informed consent, you will not be eligible. This is precisely where the law is expected to change soon, to allow advance requests, but this is not yet in effect.

Advance Medical Directives (AMD)

AMD, also known as advance healthcare directives or advance wishes, are written instructions made by a competent individual that state what medical treatments they would or would not want if they become unable to speak or make decisions for themselves.

In Québec, AMDs apply to five specific types of care — resuscitation, ventilation, artificial hydration and nutrition, and other life-sustaining treatments. They are not tied to a specific illness, and apply in any case where the person is unconscious or unable to consent.

Comparison and Key Differences

Both MAiD and AMD aim to protect patient autonomy and dignity, but they operate very differently:

MAiD is an active intervention to end life in response to unbearable suffering, and requires a specific, informed request.

AMD are passive instructions, recorded in advance, that come into effect only when a person can no longer express their wishes.

Understanding the distinction is crucial for anyone making informed end-of-life decisions — and for ensuring that healthcare professionals and loved ones respect your rights.

And where does your notary come in?

Your AMDs can be included in your protection mandate, but it's highly recommended to also register them with the RAMQ (Québec’s health insurance board). This way, any doctor in Québec can access your directives instantly in an emergency — instead of relying on family to dig through paperwork.

You can submit your AMD form directly via the RAMQ website, or ask your notary to help. Your directives can be updated at any time.

Contact us to discuss your options.