AMM/MAID au Canada : Cadre fédéral et extensions québécoises / Federal Framework and Quebec Extensions

Aide médicale à mourir (AMM) au Canada : Cadre fédéral et extensions québécoises des demandes anticipées

Cadre fédéral canadien

La législation canadienne sur l’aide médicale à mourir, régie par le Code criminel et administrée par Santé Canada, établit un système d’admissibilité à deux voies. La voie 1 s’applique aux cas où la mort est raisonnablement prévisible, tandis que la voie 2 couvre les situations où la mort n’est pas raisonnablement prévisible mais où d’autres critères sont remplis.

Critères d’admissibilité actuels :

Âge de 18 ans ou plus avec capacité de prise de décision
Admissibilité aux soins de santé financés publiquement
Demande volontaire sans pression externe
Consentement éclairé après avoir reçu les informations pertinentes
Maladie, affection ou handicap grave et incurable
État avancé de déclin irréversible des capacités
Souffrance physique ou psychologique insupportable

Les mesures de sauvegarde comprennent :

Deux évaluations médicales indépendantes
Pour les cas de voie 2 : période de réflexion de 90 jours et exigences d’expertise spécialisée
Consultation obligatoire avec les professionnels de la santé pertinents

Exclusion de la maladie mentale :
L’admissibilité pour les personnes dont la seule condition sous-jacente est une maladie mentale a été reportée au 17 mars 2027, suite aux retards législatifs de 2023 et 2024.

Source : Gouvernement du Canada – Législation AMM

Extensions provinciales du Québec

La Loi concernant les soins de fin de vie du Québec va au-delà des dispositions fédérales, notamment par les demandes anticipées d’AMM, qui sont devenues opérationnelles le 30 octobre 2024.

Dispositions sur les demandes anticipées :
Le Québec permet aux personnes diagnostiquées avec des maladies graves et incurables menant à l’incapacité (comme les maladies neurodégénératives) de faire des demandes anticipées d’AMM tout en conservant leur capacité de prise de décision. Ces demandes spécifient les manifestations cliniques qui déclencheraient l’administration de l’AMM après que la personne devienne incapable de consentir.

Exigences du processus :

Assistance d’un professionnel médical qualifié
Spécification détaillée des manifestations cliniques déclencheuses
Option de désigner des tiers de confiance
Documentation formelle par acte notarié ou formulaire témoin
Inscription au registre provincial des demandes anticipées

Conflit juridictionnel :
Le cadre des demandes anticipées du Québec fonctionne malgré l’absence d’amendements correspondants au Code criminel fédéral. Cela crée une exposition légale potentielle pour les fournisseurs de soins de santé, car la prestation d’AMM basée sur des demandes anticipées demeure techniquement interdite sous la loi fédérale.

Sources : Loi concernant les soins de fin de vie du Québec | Information gouvernementale du Québec sur l’AMM

Réponse fédérale actuelle

En octobre 2024, les ministres fédéraux de la santé et de la justice ont annoncé des consultations nationales sur les demandes anticipées, prévues pour janvier 2025. Le gouvernement fédéral a déclaré qu’il n’interférera pas avec la mise en œuvre du Québec pendant que ces consultations se déroulent.

Source : Déclaration de Santé Canada sur les demandes anticipées

Contexte statistique

Selon le cinquième rapport annuel de Santé Canada, 15 343 prestations d’AMM ont été signalées au Canada en 2023, représentant 4,7 % de tous les décès. L’âge moyen au moment de la prestation était de 77,6 ans.

Source : Rapport annuel de Santé Canada 2023

Medical Assistance in Dying (MAID) in Canada: Federal Framework and Quebec’s Advance Request Extensions

Federal Canadian Framework

Canada’s Medical Assistance in Dying legislation, governed by the Criminal Code and administered by Health Canada, establishes a dual-track eligibility system. Track 1 applies to cases where death is reasonably foreseeable, while Track 2 covers situations where death is not reasonably foreseeable but other criteria are met.

Current Eligibility Requirements:

Age 18 or older with decision-making capacity
Eligibility for publicly funded healthcare
Voluntary request without external pressure
Informed consent after receiving relevant information
Serious and incurable illness, disease, or disability
Advanced state of irreversible decline in capability
Unbearable physical or psychological suffering

Safeguards include:

Two independent medical assessments
For Track 2 cases: 90-day reflection period and specialized expertise requirements
Mandatory consultation with relevant healthcare professionals

Mental Illness Exclusion:
Eligibility for persons whose sole underlying condition is mental illness has been postponed until March 17, 2027, following legislative delays in 2023 and 2024.

Source: Government of Canada – MAID Legislation

Quebec’s Provincial Extensions

Quebec’s Act Respecting End-of-Life Care expands beyond federal provisions, most notably through advance requests for MAID, which became operational on October 30, 2024.

Advance Request Provisions:
Quebec permits individuals diagnosed with serious and incurable illnesses leading to incapacity (such as neurodegenerative diseases) to make advance requests for MAID while retaining decision-making capacity. These requests specify clinical manifestations that would trigger MAID administration after the person becomes incapable of consent.

Process Requirements:

Assistance from qualified medical professional
Detailed specification of triggering clinical manifestations
Option to designate trusted third parties
Formal documentation through notarial act or witnessed form
Registration in provincial advance request registry

Jurisdictional Conflict:
Quebec’s advance request framework operates despite the absence of corresponding federal Criminal Code amendments. This creates potential legal exposure for healthcare providers, as MAID delivery based on advance requests remains technically prohibited under federal law.

Sources: Quebec Act Respecting End-of-Life Care | Quebec Government MAID Information

Current Federal Response

In October 2024, federal health and justice ministers announced national consultations on advance requests, scheduled for completion by January 2025. The federal government has stated it will not interfere with Quebec’s implementation while these consultations proceed.

Source: Health Canada Statement on Advance Requests

Statistical Context

According to Health Canada’s Fifth Annual Report, 15,343 MAID provisions were reported in Canada during 2023, representing 4.7% of all deaths. The average age at time of provision was 77.6 years.

Source: Health Canada Annual Report 2023

Pour des informations complètes sur les critères d’admissibilité et les procédures, consultez : Aperçu de l’AMM de Santé Canada

For comprehensive information on eligibility criteria and procedures, consult: Health Canada MAID Overview

13th September 2025

Conflicts of Vital Interest

Re: Ireland, Tom (2025, September 8) Six-legged suffering. The Biologist. September

(1) The evidence of sentience and suffering in all vertebrates is beyond any reasonable doubt.

(2) The evidence of sentience and suffering in some (perhaps eventually all) invertebrates is growing.

(3) The only ethical principle that can be applied is for humans to refrain from causing suffering in sentient organisms wherever it is physically possible, except where it is vitally necessary for human survival and health.

(4) Ethical principle (3) is not yet being applied in the human consumption of (1) even though it is already, and has long been, maximally pressing.

(5) Applying (3) to (2) will probably become more pressing with evidence and time.

(6) Is preoccupation with (5) now likely to delay applying (3) to (1)?

24th June 202524th June 2025

Free Will

Ibsen’s The Lady from the Sea is about the human sense of freedom. Ellida fell in love with a sailor on a brief port call when she was young. They became “engaged” and symbolically married by throwing their rings into the sea, and he said he would come back for her and leaves. As time goes by she becomes obsessed with the sea, feeling as if she is married to the sea, and part of the sea.

This is the 19^th century and women are dependent on men for their sustenance, and there are still widely shared feelings about the inviolateness of marriage vows. Ellida marries a widower, a kindly doctor, with two daughters, and bears a son, who dies very young (age 3). Ellida is distraught at his loss. She is close to the older daughter, Bolette, but the younger daughter, Hilde, rejects her, and is childishly rude to her, because she feels Ellida is rejecting her.

The older daughter’s aging former-tutor comes to visit; he is in love with his former pupil. She, on the other hand, is just yearning to learn, about life, and the world.

There is also a young man, in frail health, not expected to live long. He is yearning to become an artist, and naively contemplating courting the older daughter. But he is also contemplating (perhaps unrealistically) going away to become an artist.

The sailor returns, as promised. Ellida had told the doctor, when he was courting her, that there had been someone in her past. He had accepted it and not pursued it further. She now tells him the full story about the “engagement” and “marriage”, and the sailor’s vow to return, and her vow to wait for him. But in the meantime it had been discovered that he had killed the captain (for an unknown reason) and fled, and Ellida had thought he was gone forever, or had perished. That was what was underlying her passion for the sea; she also felt that her son had eyes like him, and the sea.

So Ellida is yearning for her lover, and for the sea that embodies him and her yearning. She ceased physical relations with her husband at the death of her son, because she felt his death was a punishment for breaking her vows to the sailor in marrying the doctor for survival, vows which she feels she has kept in her heart, and has never stopped yearning for the sailor, and their sea.

The sailor, who has never stopped yearning for Ellida, has returned, hoping she would fulfill her vow. The young, frail man is yearning to go off into the world and become an artist, and then return to marry. The aging tutor is yearning for the older daughter, his pupil, to return his love and marry him. The older daughter is yearning to go into the world to learn, but does not have the material means, The younger daughter is just toying with the frail young man; she is still yearning for maternal love, from Ellida, having lost her own mother.

Ellida needs freedom to discover her own decision, otherwise she is bound by the love of the sailor, her vow to him (and herself) and her vows to her husband (who is good, and loves her selflessly, despite her past, their lost child, and her physical withdrawal from him). He struggles internally (he had naively thought that the man in her past had been the aging tutor), and then, according to his nature, he grants Ellida her moral freedom, and this enables her, in the last moment, to break her vow to the sailor.

In a microcosm, the same happens with the older daughter and the aging tutor: He proposes to her, she declines, because she does not love him; he says he accepts to show her the world nevertheless, with only the hope that she might one day learn to love him. She senses that he really means this, and accepts it, without vows.

The frail young artist, who had seemed to be courting the older daughter, cheerfully declares to the younger daughter that once he has become an artist, he may return and court her instead, because she is closer to his age.

Everyone sees that the doctor, who had been ready to leave his beloved lifelong home and region with Ellida in the hope that it might cure her of her obsession with the sea (and the sailor), is close to Ellida again, and she to him. She finally shows love to the petulant younger daughter, who needed it most, and immediately reciprocates.

16th March 202516th March 2025

עַיִן תַּחַת עַיִן

ANON: “Is co-habitation and occupation of land an equal sin to that of murdering another human?”

Taking and losing life and taking and losing “land” are all done by, and done to, individual people. You can’t quantify or equate “sin” without counting individual doers and individual done-to’s, individual victims and individual perpetrators, on “both” sides.

Taking “land” includes taking everything else that individual lives are lived for (including family and freedom).

Perhaps the most telling detail of this tragedy — which has individual victims on “both” sides – is that there aren’t just two sides:

The individual victim-counts and the individual perpetrator-counts, for both “land”-taking/losing and life-taking/losing, start long before 1949 and beyond “Palestine” (which I take to be a geographical region, not a further metaphysical or moral entity).

The “takings” are not just local, in either place or time, although individuals remain individuals and local (when it comes to counting victims and perpetrators).

All of this could have been said of the taking of both life and “land” throughout the entire history of humanity (and inhumanity), planet-wide. It even has a biological basis (and it goes beyond the boundaries of species):

Life necessarily entails conflicts of interest – vital (i.e., life-or-death) interest. And “land” covers a multitude of vital interest, not just real-estate or geometry: it covers just about everything that life is worth living (or dying or killing) for.

So, no, if there were a measure of degree of “sinfulness”, it could not be expressed as life vs. land.

There is, of course, more to say; much more. But it’s best to expose simplistic metrics before starting the counting.

25th February 202525th February 2025

Certainty: “Cogito” vs. “Sentio”

SH: Please compare “Sentio, ergo sentitur“ to “Cogito, ergo sum”.

GPT-4: “Sentio, ergo sentitur” is as epistemically solid as the Cogito but avoids unnecessary metaphysical commitments. It asserts only the occurrence of feeling, not the existence of a self.

SH: That’s exactly the aim: to assert what is certain, incontrovertible. I think the Cogito is over-reaching, implying that (a) the fact that a feeling (thinking) is being felt makes it indubitable, hence certain eo ipso that (b) a feeler (thinker) “exists” — whereas (b) is just imported assumptions, not part of the self-evident, undoubtable argument.

GPT-4: “Sentio, ergo sentitur” captures only what is certain and indubitable—that feeling is occurring. It avoids the unnecessary leap from experience to the assumption of an experiencer (a “self” or “thinker”), which Descartes smuggles in with “sum.”

Your formulation is more rigorously minimalist than the Cogito because it does not overreach beyond what is actually self-evident. It is a pure phenomenological statement, grounded entirely in what is felt, not who is feeling.

If the goal is to assert only what is certain—without presuppositions—then “Sentio, ergo sentitur” is the better starting point than the Cogito.

Would you like to develop a stronger counterargument against the Cartesian assumption of the self, or do you think this already suffices?

SH: I think it should be sufficient to point out that the “self” wrapped into the Cogito is a speculative non-sequitur (imposed by 1st person syntax) and leaves the Cogito wide open to doubt. In contrast, the Sentio is as indubitable as formal necessity (non-contradiction). (I am not a phenomenologist at all; I am a sentience activist!)

GPT-4: Yes, this is not phenomenology in the Husserlian sense but rather a sentience-first epistemology—stripping away the metaphysical baggage to affirm what matters: that feeling occurs, and that this undeniable fact is the only foundation that needs to be recognized.

For a sentience activist, this position is much stronger than the Cogito, because it does not hinge on an abstract “self” but on the reality of feeling itself, which is what actually matters—both epistemically and ethically.

Would you say that “Sentio, ergo sentitur” could serve as a more precise, non-anthropocentric foundation for grounding sentience in ethics as well?

SH: Not really. First, I don’t think the Cogito, whether as originally proposed by Descartes, or when the non-certain ontological baggage is dumped, ever provided a “foundation” for science, as purported. It was just a slight narrowing of the territory susceptible sceptical doubt.

But science was never destined to be about certainty, just probability on the evidence so far: provisional and approximate. It had previously seemed as it it only formal logic and maths that could provide certainty (logical necessity, on pain of contradiction). What the Cogito would have provided, if scaled down to the Sentio, is one other thing about which a human could be certain, which is that I feel (when and while I am feeling).

That’s something, but it’s not a “foundation” for anything, either scientific or epistemological (let alone ontological, though it does point out that feeling is a second certainty). But, of course, certainty itself is just a feeling! One can feel certain about the truth of something that is not in fact true; it only feels true, to you. Nor does feeling provide a foundation for ethics, except in the sense that it is the only thing ethics is about, and without sentience there would be no ethics.

GPT-4: I agree that the Cogito, even in its stripped-down form, was never a real foundation for science—not in the way Descartes imagined. Science doesn’t deal in certainty but in empirical probability, always provisional and subject to revision based on new evidence. The only domain where certainty holds is formal necessity—mathematics and logic—where contradiction is not permitted.

What “Sentio, ergo sentitur” does provide, however, is one more certainty beyond formal necessity: the fact of feeling when and while one feels. But as you point out, this is not a foundation for science, epistemology, or ontology—just an undeniable fact about sentience itself.

And yes, certainty itself is just a feeling—one can feel certain about something false, which makes subjective certainty unreliable as a basis for truth. Feeling is not a foundation for ethics either, but it is the only relevant content of ethics: without feeling, there would be no reason for moral concern, because nothing would matter to anyone or anything. Ethics is about sentience, not grounded by it.

This makes sentience-first ethics fundamentally different from rationalist or deontological ethics: it doesn’t start from rules, reason, or duty, but from the fact that feeling exists and that it is the only thing that can be harmed or benefited.

6th November 2024

November 5, 2024: Musketears

The Economist, as usual, thinks it’s about the Economy, Stupid – not Ethics, Equity, or Eternity. I weep for the Earth, and its critters – except the perpetrator, Anthropos (though even there it will be mostly innocent victims who bear the brunt, not the concupiscents responsible, nor even the stupid ones, clueless…). What has really prevailed (to paraphrase Bertrand Russell — who was close) is the foul odor of Musk.

19th August 202419th August 2024

“Workman, blame not thy tools!”

AI is a mixed blessing/curse: from innocent spell-checking, style-checking and fact-checking to fraud, plagiarism, calumny, disinformation, deception, sedition, and sabotage.

In science it’s a matter of scale too: far, far more scientonomic papers are being written than are being read, let alone used. They are just being counted. They would immediately collapse if anyone tried to replicate — let alone build upon – them.

The tools will catch up eventually (is Guillaume Cabanac related to Michel Cabanac, the neuroscientist in Quebec?), but, as usual, it will be an arms race (“spy vs. spy”) – and we may already have committed terminal, irreversible biocide. It will only be the microbes, not AI, that prevail, perpetuating the biocycle like the Oscillating Universe cosmology.

Jeremian or Cassandrian?

(Full disclosure. I consulted ChatGPT about whether there are any more idiomatic homologues: unless misinformed, there aren’t any…)

Ceterum censeo: There is no such thing as AGI, probably for the same reason there is no synthetic sentience – which is not to say that there cannot be Abiogenesis. AI, in contrast, is just plain old anthropogenic tomtoolery (sic)

17th August 2024

Tachylalic Tales

speed-of-light bibliophagy

tachyonic AI-modelling-to-action

cooking Canada

follow the money

Oceania vs. Eurasia vs. Eastasia

drone vs. drone

not sci-fi

can’t think of anything

anyone could do about it

DNA hurtling

toward digital dystopia

and biocide

and the breathless, gormless

geeks soldier on

increasing the Trumps’ ocean-front real estate

11th August 2024

Open Access and OpenAI

https://phys.org/news/2024-08-junk-ai-scientific-publishing.html

This is the era we’re in, where Gold AI has met ChatGPT.

It will partly sort itself out (for those with good intentions), by AI’s version of Mad Magazine’s Spy vs. Spy, with AI vs AI (AI-detecting AI). But, as in disinformation and cybercrime, the bad actors will do their worst, and it will be an endless arms race until/unless failsafe encryption emerges and prevails.

Full disclosure: I’ve started using ChatGPT to help me edit down badly written, wordy and repetitious commentary submissions to Animal Sentience that nevertheless have some redeeming substance by compressing them into more acceptable commentaries.

15th March 2024

A SCOTUS Hermeneutics Exercise for ChatGPT4

Re: “Supreme Betrayal A requiem for Section 3 of the Fourteenth Amendment” By J. Michael Luttig & Laurence H. Tribe The Atlantic March 15 2025

SH: [Query to ChatGPT4]: Could you please first summarize the following passage to show you have understood it, and then give some arguments to support that “2 + 2 = 4” is false and that “water is not wet” is true.

“The needless, rushed, and astoundingly stupid decision of the US Supreme Court has made it crystal clear that, in incompetent (and malevolent) hands, interpreting the constitution has become like Microsoft trying to patch obsolescent and increasingly contradictory legacy code when what is really needed is a bottom-up rewrite. Holding back the ocean with sandbags comes to mind too. And of course, the infinite pliancy of Holy Writ, under the hermeneutics of zealots of any persuasion. Maybe language itself is to blame too. A good exercise for ChatGPT is to give it a true proposition, like “2+2=4” or “water is wet” and ask GPT to find an interpretation under which it is false. Not one, but a countless number of interpretations can always be found that will do the job.(Vice versa works for false propositions too.)”

ChatGPT4:

The passage criticizes the U.S. Supreme Court’s decision, suggesting it reflects a lack of competence and possibly malevolence in interpreting the constitution, likening the situation to attempting to update outdated and conflicting software or trying to hold back the ocean with sandbags. It highlights the flexibility with which holy texts can be interpreted by zealots of any persuasion and suggests that language’s inherent ambiguity contributes to these problems. The author proposes a thought experiment for GPT, challenging it to reinterpret universally accepted truths (such as “2+2=4” or “water is wet”) as false, to illustrate the point that language and interpretation can significantly alter perceived truth.

To engage with the exercise proposed:

Arguing that “2 + 2 = 4” is False

In a non-standard mathematical system or under certain interpretations, “2 + 2 = 4” could be considered false. For instance, in modular arithmetic, which deals with remainders after division by a certain number (the modulus), “2 + 2” does not necessarily equal 4. Specifically, in modulo 2 arithmetic, 2 + 2 = 0, because 4 divided by 2 leaves a remainder of 0. This example demonstrates that, depending on the mathematical rules and systems we agree to use, the truth of “2 + 2 = 4” is not absolute but contingent upon those systems.

Arguing that “Water is Not Wet” is True

The statement “water is not wet” can be supported by redefining or closely examining what it means to be “wet.” Wetness is a condition that applies to a solid object when it comes into contact with a liquid, such that the liquid adheres to the object’s surface in a layer. However, water itself is a liquid and does not become wet but instead causes other materials to become wet. From this perspective, saying “water is wet” is akin to saying “water makes water wet,” which is a misunderstanding of the conditions required for wetness. Thus, one could argue that water, in its capacity to induce wetness but not be in the state of wetness itself, is not wet.

SH: Very good. Both arguments are the prima facie ones I expected. Now could you please give one further argument in each case, to show that there’s not just one way to do it?

ChatGPT4:

Certainly, let’s explore an additional argument for each proposition:

Further Argument that “2 + 2 = 4” is False

One might consider the realm of philosophical argumentation, specifically nominalism, which suggests that abstract objects like numbers do not exist outside of our minds. From this viewpoint, “2 + 2 = 4” is an agreement within a human-constructed symbolic system rather than an eternal truth. If one were to argue from a radically different conceptual framework—where the symbols “2”, “+”, and “4” have different meanings or where the concept of “addition” is not defined in the way we commonly understand it—the statement “2 + 2 = 4” could be seen as false. For instance, in a hypothetical culture where quantities are expressed not by exact numbers but by qualitative measures (much, little, enough), the precise operation “2 + 2 = 4” loses its meaning and thus its truth value could be considered as not true within that conceptual framework.

Further Argument that “Water is Not Wet” is True

Exploring the semantics of “wetness” can provide another avenue for arguing that “water is not wet.” One might argue that wetness is a perceptual phenomenon rather than an intrinsic property of substances. That is, an object is perceived as “wet” when it significantly alters our sensory experience of it, particularly through touch. Water itself does not undergo such a change in state; it is always in the same state. Therefore, it does not meet the perceptual criterion for wetness that a dry object does when it comes into contact with water. From this perspective, wetness is an emergent property that arises from the interaction between a liquid and a material that can absorb or be coated by the liquid. Since water itself cannot be coated by or absorb itself, it cannot be considered “wet” according to this definition of wetness as an emergent, perceptual property.

SH: Yes, and it can go on and on like that, with ever more fanciful interpretations, by adding more and more fanciful premises. Demagogues, devious lawyers, sophists, quacks, psychopaths, and theologians are particularly adept at this — and they all have the bottomless resources of language, rhetoric, and now LLMs to draw upon…