Admissions

Since we are a non-profit organization, there are no fees for the care and services offered at La Maison. However, adult briefs and nutritional supplements such as Boost or Ensure are not included. In addition, the patient or their loved ones will be required to pay for medication as if the patient were at home, i.e., they will have to pay the amount not covered under private insurance or by the Régie d’assurance maladie du Québec (RAMQ). Meal fees apply only for loved ones accompanying the patient and having meals with them at La Maison.

Upon arrival, the patient’s family must provide a valid credit card number to process the pharmaceutical charges.

The list of required personal items may be downloaded by clicking on the button below. Our apologies, the document is only available in French. List of required personal items to bring when you are admitted to La Maison de la Sérénité.

• Health insurance card ;
• Private insurance card ;
• Personal medication for the first 24 hours (our pharmacy will take over afterwards) ;
• Comfortable clothing, pyjamas ;
• Personal hygiene products ;
• Tissues ;
• Lip balm ;
• Shoes and/or non-slip slippers ;
• Your own pillow, if desired ;
• Incontinence briefs, if necessary ;
• A walker, if necessary ;

Download List

Please note that each room is equipped with the below items:

• A television ;
• A phone ;
• A radio ;
• WIFI internet ;
• A microwave ;
• A small fridge ;
• A sofa-bed for the family ;
• A wheelchair ;

We look forward to welcoming you at La Maison! For any questions, please contact the Assistant to the Nursing Care Coordinator at 450 936-4300, ext. 251. Or by email: adj.soins@maison-serenite.ca. A sofa bed and linens are provided for visitors who wish to sleep in the room. The staff must be notified before the overnight stay.

If the patient is hospitalized, the hospital professional will organize the transportation of admitted patients to La Maison de la Sérénité, depending on their level of self-sufficiency. If the patient is at home, our Nursing Care Coordinator will assess the best means of transportation with a member of the patient’s family or by ambulance if required.

The survey on client satisfaction, is sent to each family a few weeks following the passing of their loved one, is an evaluation tool vital for La Maison de la Sérénité. Our client’s satisfaction is central to our continuous efforts to improve the quality of our care and services.

It allows:

• To ensure that our services meet our patient’s needs and expectations ;
• To identify factors of satisfaction and dissatisfaction ;
• To anticipate needs and expectations ;
• To foster interest and mobilize staff by publishing satisfaction results.

 

For the financial year of 2024-2025, the satisfaction rate for all services and care offered at La Maison was very high. These results are the product of the efforts of all our employees and volunteers, who are dedicated to making the stay of our patients and loved ones as welcoming as possible and meeting their needs and expectations.

When the disease progresses slowly and the discomfort is well alleviated, some people no longer require end-of-life care services for some time. About three months after the stay begins, the individual whose condition is stable may be relocated somewhere other than a palliative careresidence. That decision is made following a medical assessment and discussion with the patient and their loved ones. This is done according to the patient’s needs and their situation. The patient may be relocated to a nursing home, intermediary resource, or their home. If applicable, the costs of this transfer are at the expense of the patient and their family.

Preamble

The Act respecting end-of-life care (hereunder «the Act») was sanctioned on June 10, 2014, by the Assemblée nationale du Québec and came into effect on December 10, 2015.

The Act proposes a general and unified view of care and rights for people at the end of their lives. It ensures that they receive care that respects their dignity and their autonomy, and it recognizes the importance of a person’s clearly and freely expressed wishes regarding care.

The Act provides specific provisions for palliative care homes in terms of end-of-life care services, as well as the supervision and organization of such care. It also aims to specify the legal, ethical and clinical standards that should guide the provision of care and services for individuals at the end of life. 

La Maison de la Sérénité is a non-profit organization holding accreditation issued by the Minister in accordance with the second paragraph of article 457 of the Act respecting health services and social services (hereunder the « LSSSS ») having reached an agreement under article 108.3 of the LSSSS with an establishment by vertu of obtaining all or part of the care required by end-of-life patients who use these services.

La Maison de la Sérénité’s mission is to offer free specialized palliative care for people at the end of life. La Maison de la Sérénité embraces the palliative care philosophy, which recognizes the right to dignity, truth and respect for each person’s uniqueness and individuality.

Palliative care is a human way to accompany life, based on values such as empathy, dignity, respect and self-giving.

La Maison de la Sérénité is a place of expertise, a place where you are heard and guided. It is where people at the end of life and their loved ones receive the care necessary for their condition throughout their stay. The care aims to ensure the patient is comfortable; therefore, no treatment is administered to prolong life.

La Maison de la Sérénité has adopted an end-of-life care policy to define and support the care and services offered.

• DEFINITIONS

People at the End-of-Life 

Anyone who receives health care and services within La Maison de la Sérénité.

Caregiver 

Anyone who provides significant ongoing or occasional non-professional support to a person with a loss of autonomy could be a family member or a friend, is considered a caregiver.

Palliative Care Home

Palliative care homes are private non-profit organizations, managed by a self-contained board of directors, which make considerable room for the contribution of volunteers. They are holders of an agreement delivered by the Minister, which allows them to provide palliative and end-of-life care to the people concerned and to support their loved ones right through the mourning phase.

Ability to Consent to Care 

The person’s ability to understand the nature of the illness for which an intervention is suggested, the nature and the goal of the treatment, the risks and benefits of the latter, whether they receive it or not.

Treatment Discontinuation

Cessation of care or treatment.

Refusal of Care

For a person to refuse care, treatment, an intervention or to be accommodated or hospitalized.

Guarded Prognosis

Unfavourable forecasts related to the progression of a disease or the severity of injuries, according to which the person’s chances of survival in the more or less long term are compromised.

Palliative Care

The total and active care delivered by an interdisciplinary team to patients suffering from a disease with a guarded prognosis, in order to relieve their suffering, without delaying or hastening death, maintain the best quality of life possible and provide them and their caregivers the support they need.

 

End-of-life Care 

Palliative care is provided to end-of-life patients and medical aid in dying.

Continuous Palliative Sedation (CPS)

Care consists of “giving medication to a person at the end of life to ease their suffering that has become severe. To achieve this, these drugs put the person to sleep until they die. The person is then in an unconscious state.”  

Medical Aid in Dying (MAID)

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.

Advanced Medical Directives (AMD)

Directives given by a person with the capacity to consent to care regarding decisions to be made about care if they are no longer able to make them. However, such directives cannot be used to request medical assistance in dying.

Authorized Third Party

If the person who has consented to palliative sedation or medical aid in dying cannot sign and date the form because he or she cannot write or is physically unable to do so, a third party may do so, in their presence. However, this third party cannot be a member of the care team responsible for the person, a minor or an adult who is incapacitated. In accordance with article 27 of the Act and taking into account section 241.2 (4) of the Criminal code, this third party cannot be a member of the care team responsible for the person, a minor or an adult who is incapacitated and who does not know or believe that they are a beneficiary under the will of the person making the request, or a recipient, in any other way, of a financial or other material benefit resulting from that person’s death. The third party must also understand the nature of the request for medical assistance in dying. 

 

Interdisciplinary Support Group 

An interdisciplinary support group that assists care teams, at their request, with the clinical and administrative aspects of any request for medical assistance in dying. The team also supports CISSS decision makers in ensuring the quality and availability of resources.

Witness

Any person of legal age who will not directly participate in the care of the person requesting medical assistance in dying and who does not expect to receive a benefit, testamentary or otherwise, following the patient’s death.

 

2.GENERAL PROVISIONS

• PURPOSE OF THE POLICY

Article 15 of the Act stipulates that “every palliative care hospice must adopt a code of ethics concerning the rights of patients with respect to end-of-life care and adopt a policy for end-of-life care.” Article 15 also stipulates that “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 patients whose condition could require end-of-life care and their close relations.” Article 19 of the Act also stipulates that these documents must take account of ministerial guidelines.

The policy applies only in the context of end-of-life care, where various care options and methods are possible depending on the condition and wishes of the individual. It helps to situate the patient’s path, thus providing a better understanding of the contribution of palliative care in an end-of-life context and of the other care options provided for by law.

• LEGAL AND ETHICAL FOUNDATIONS

The policy hereby is based on the following legal foundations:

• Users’ rights, as specified in Article 5 of the Act respecting health services and social services and, which states that “every person is entitled to receive, with continuity and in a personalized and safe manner, health services and social services which are scientifically, humanly and socially appropriate.”
• The guidelines guiding the management and provision of health and social services, as stipulated in section 3 of the LSSSS, in particular, the one specified in paragraph 3: “the user must be treated, in every intervention, with courtesy, fairness and understanding, and with respect for his dignity, autonomy, needs and safety.”
• Users right regarding access to end-of-life care as specified in Article 4 of the Act, which states that “every person, whose condition requires it, has the right to receive end-of-life care, subject to the specific requirements established by this Act”.
• Palliative care houses are community-based, non-profit legal entities managed by member-elected boards of directors drawn from the people the homes serve and members of the communities they serve. They are independent and self-reliant, and their status concerning the LSSSS has been clarified by the administrative framework for palliative care homes set in place in 2008.
• The obligation of palliative care homes, as stipulated in article 13 of the Act, is to determine, “the end-of-life care provided in their premises. However, no palliative care hospice may exclude medical aid in dying from the care it offers.” Paragraph 2 of the same article clarifies, “Every palliative care hospice must inform persons of the end-of-life care it offers before admitting them. No palliative care hospice may refuse to admit a person for the sole reason that they have requested medical aid in dying.” 

Ethical considerations also arise in the context of end-of-life care, and this policy is based on the following two principles:

• Principle of benevolence 

Refers to caring for others, for who they are, while respecting what they consider to be good for them. The definition of what is “good for them” must take into account what the person wants, not what the care team believes is good for them.

 

• Principle of autonomy

Refers to the freedom and personal decision of a person faced with a choice. This principle suggests that everyone knows what is good for them. Being able to recognize a person’s autonomy means giving them access to the information that will enable them to define their own good and thus make the decision they feel is best for them.

• MINISTERIAL GUIDELINES

In organizing end-of-life care, palliative care homes must comply with certain ministerial guidelines. Particularly, they must adopt an end-of-life care policy as well as a code of ethics.

Some guidelines have a more general scope, like those coming from the Politique en soins palliatifs de fin de vie (2004) which are presented in the form of main objectives, such as

• Fair access to services.
• Continuity of service between different provision sites.
• Quality of services offered by interdisciplinary teams.

Other guidelines are more targeted, making it possible to put forward specific actions such as those set out in the Cadre de référence sur le développement des compétences en matière de soins palliatifs et de fin de vie (2015), including to:

• Promote the development of the skills required to ensure the quality and safety of care and services offered to people receiving palliative and end-of-life care.
• Take into account the experience of each member of the team and volunteers.
• Empower staff members and volunteers to act according to a collaborative practice approach.
• Modify attitudes and perceptions of the staff members to develop interpersonal skills and encourage a real change in practice.

 

• VALUES AND GUIDELINES

Preamble

La Maison de la Sérénité embraces the palliative care philosophy, which recognizes the right to dignity, truth and respect of each person’s uniqueness and individuality. The following values and guidelines guide the care services already provided by La Maison de la Sérénité. They serve as a guide for all doctors, staff and volunteers working at La Maison. They involve a close partnership with patients, their families and loved ones. Since its opening in 2009, these values are based, among other things, on reflections inspired by the main work done in Quebec and Canada over the last decade. 

The Politique en soins palliatifs de fin de vie (2004), the Commission spéciale sur la question de mourir dans la dignité report (2012), the Canadian Hospice Palliative Care Association’s model of palliative care (2013) and, more recently, the passage of the Act respecting end-of-life care (2014), are just a few examples.

Values 

• The inherent value of each person as a unique individual.
• The very high value of life. 
• The necessary participation of the person in decision-making is helped by the rule of voluntary and informed consent. 
• The individual’s right to be informed according to their wishes on all matters concerning them, including their actual condition, and the respect of their choices. 
• The duty of confidentiality of each representative, which prevents the disclosure of any personal information to third parties, unless the individual authorizes them to do so.
• The right to compassionate services from caregivers, respecting what gives meaning to a person’s existence such as their values, culture, religious beliefs and practices, as well as those of their loved ones.

 

Guidelines:  

 

• The participation of each individual in the decision-making process is undeniable. 
• Illness and death are stages in life where everyone’s potential for achievement needs to be supported and enhanced.
• The compassion of those involved is an essential attitude for presence, attention and action.
• People at the end of life and their loved ones are at the heart of our concerns.
• Quality of life and the relief of any end-of-life symptoms are the driving forces behind our interventions.
• The responsibility for quality care is shared according to our respective competencies.

 

• ADMISSION REQUIREMENTS FOR ALL PATIENTS OF LA MAISON DE LA SÉRÉNITÉ

La Maison de la Sérénité offers free services to adults in need of palliative care. To be admissible, they must meet the following criteria: 

• • Live in Laval or have a significant family member living there.
  • Be 18 years of age or older.
  • Not live in a residential and long-term care centre (CHSLD).
  • Have a life prognosis of less than three months.
  • No longer receive curative treatment.
  • Understand the advanced state of their illness.
  • Accept that any medical follow-up will be carried out by the team of doctors at La Maison de la Sérénité only.
  • Know about La Maison de la Sérénité’s mission.
  • Agree to spend the last days of their lives at La Maison de la Sérénité.
  • Have a level “D” of therapeutic intervention, i.e. all care interventions are intended to ensure the patient’s comfort without aiming to prolong life.

• A patient who has been deemed eligible for medical assistance in dying by an evaluating doctor must have, at most, the 2nd medical evaluation completed (opinion #2). The first medical evaluation (opinion #1) will be carried out by a doctor from La Maison de la Sérénité.

• PALLIATIVE CARE PHILOSOPHY

The World Health Organization defines palliative care as “an approach that improves the quality of life of patients and their families facing life-threatening illness, through pain and symptom relief, psychological, social and spiritual support.” 

• The patient is seen as a being in their own right, living until the very end.
• The religious beliefs and cultural, personal and social values of the patient and their family are respected.
• The emotional needs of the patient and their loved ones are listened to, and the involvement of warm-hearted, attentive staff is encouraged.
• The great worth of life is valued, and death is considered a normal stage of life.
• The natural and normal evolution of the disease is monitored and engaged.
• The patient has the right to truth, dignity, privacy and confidentiality.
• The patient’s right to make informed decisions is valued, and they are encouraged to express their wishes regarding the choice and organization of their care.
• The notion of quality that guides our interventions is the one defined by the patients themselves.
• Respect, comfort and dignity are at the heart of the palliative care commitment.

 

• PURPOSE OF PALLIATIVE AND END OF LIFE CARE

• Improve the patient’s quality of life by adequately controlling the various symptoms associated with the disease.
• Offer the end-of-life patients and their loved ones an alternative care environment that recreates the home feel as much as possible.
• Involve family and loved ones in the care process.
• Help patients live with dignity until death.
• Offer respectful and thoughtful support to loved ones.
• Allow patients to choose their next of kin.
• Include loved ones as part of our care as part of the same system. Interventions are adapted to the family system of which the patient is a part. 
• Provide care and support through the presence of trained healthcare professionals and volunteers. 
• Choose to work as part of an interdisciplinary team to encourage the expression and satisfaction of the multiple needs of patients and their families.
• Preserve the well-being of staff members.
• Raise awareness and inform the public about the palliative and end-of-life care philosophy to help change the way our society looks at end-of-life and death.
• Promote a more compassionate approach to death and quality palliative care among the various resources in the community.
• Provide care with consideration for the individual, their personal, cultural and religious values, of their beliefs and related practices.

• SCOPE OF APPLICATION

This policy applies to all staff working at La Maison de la Sérénité (managers, employees, doctors, volunteers, students and interns) who contribute, directly or indirectly, to the organization, planning, provision and improvement of care and services offered at La Maison de la Sérénité.

 

• ROLES AND RESPONSIBILITIES

Several people and organizational authorities of La Maison de la Sérénité have roles and responsibilities regarding the care they provide to ensure that ministerial guidelines are applied and that there is a significant contribution towards achieving the objective of offering quality care and services that respect individual rights and choices.

 

• GENERAL ROLES AND RESPONSIBILITIES OF LA MAISON DE LA SÉRÉNITÉ

• INFORMATION FOR PEOPLE AT THE END OF LIFE 

It is essential that La Maison de la Sérénité makes available to people at the end of life and their loved ones all relevant information concerning the provision of palliative and end-of-life care within La Maison, as well as access to and availability of such care and services.

In this respect, La Maison de la Sérénité undertakes to use a variety of communication strategies, including:

• The welcome guide (explanation of operation and rules of La Maison de la Sérénité) is available for each person and their loved ones at the time of admission.
• This policy, the code of ethics and the palliative care clinical program are available on La Maison de la Sérénité’s website. 
• Publications (informative leaflets) are available from our partners in the health and social services network.

• SERVICE OFFERING

La Maison de la Sérénité undertakes to provide specialized palliative and end-of-life care and support on every level to people at the end of life and their loved ones. La Maison de la Sérénité welcomes adults aged 18 and over, with cancer or with a chronic terminal disease, who live in Laval or have a significant relative living there.

People at the end-of-life, who freely choose to come and spend their final days at La Maison de la Sérénité, must be referred by a healthcare professional and have a life prognosis of less than 3 months. 

People are informed that any treatment available to heal or modify the course of the disease is no longer appropriate and that only the relief of symptoms is indicated for optimal quality of life. 

La Maison de la Sérénité adopts an interdisciplinary approach that promotes collaboration between caregivers, people at the end of life and their loved ones.

La Maison de la Sérénité provides palliative and end-of-life care as defined and governed by the Act respecting end-of-life care, including continuous palliative sedation when indicated by the person’s condition at the end of life. People admitted at La Maison de la Sérénité can if they wish, during their stay, receive medical assistance in dying.

La Maison de La Sérénité provides palliative and end-of-life care which mainly includes:

• Support of the patient and their loved ones.
• Relief of pain and other symptoms.
• Psychological, psychosocial and spiritual intervention and support.
• A support system that allows the patient to live as actively as possible until the end.
• Palliative sedation is when the dying patient suffers from symptoms that are difficult to relieve.
• At the patient’s request, medical assistance in dying is available.

• CLINICAL PROGRAM FOR PALLIATIVE AND END-OF-LIFE CARE 

La Maison de la Sérénité has acquired a clinical program for palliative and end-of-life care as provided for in the Act. This program defines more precisely the services offered as well as the norms and standards of practice used to guide the provision of care. Through the application of this program, La Maison de la Sérénité ensures the quality of care delivered to people at the end of life and their loved ones during their stay.

• CODE OF ETHICS

La Maison de la Sérénité has adopted a code of ethics and conduct to set out its commitment to providing quality care and services that respect the rights of individuals and the values of the organization. 

The code of ethics and conduct of La Maison de la Sérénité specifies what the people admitted can expect, including:

• To receive palliative and end-of-life care. 
• To consent to or refuse care. 
• To receive care that respects their dignity. 

The code of ethics and conduct is distributed to all employees, volunteers and doctors of La Maison de la Sérénité. It is available on the website and is available to people at the end of life and their loved ones in the welcome guide.

• AGREEMENT WITH THE CISSS OF LAVAL

Since 2007, La Maison de la Sérénité has established an agreement with the CISSS of Laval which identifies and defines the mechanisms for collaboration, coordination and communication between them.

• BOARD OF DIRECTORS

About this policy, the board of directors of La Maison de la Sérénité has the following responsibilities:

• Adopt the policy, its modifications from year to year and the admission criteria. 
• Review reports submitted by General Management and ensure follow-ups on the rendering of accounts.

• GENERAL MANAGEMENT

The General Management of La Maison de la Sérénité has the responsibility to ensure managers, employees, professionals and volunteers apply and respect this policy. 

It must also support the implementation of initiatives to update La Maison de la Sérénité’s service offering. 

At each board meeting, it reports on the organization’s direction, management and performance in light of the strategic orientations established by the Board of Directors.

• MEDICAL MANAGEMENT

With regard to this policy, Medical Management has the following responsibilities:

• Adopt clinical protocols for continuous palliative sedation in collaboration with the nursing coordinator, in accordance with ministerial recommendations.
• Evaluate the quality of the medical care provided, especially concerning applicable clinical protocols.
• Fill out the prescribed form for continuous palliative sedation at the request of a person at the end of life and keep a register of continuous palliative sedation administered at La Maison de la Sérénité with the collaboration of the care coordinator.
• Maintain an up-to-date medical on-call list in conjunction with the doctors working at La Maison. This on-call list ensures that a doctor is available on-site or on call 24 hours a day, every day.

Ensure that all requests for medical assistance in dying are processed and followed up with the Interdisciplinary Support Group.

• NURSING CARE COORDINATOR

With regard to this policy, the Nursing Care Coordinator has the following responsibilities: 

• Monitor, evaluate and update this policy.
• Coordinate and support activities related to the updating of La Maison de la Sérénité service offering. 
• Ensure that caregivers’ qualifications are in line with standards of practice, and if necessary, identify skills development needs. 
• Ensure the values on which this policy is based are respected. 
• Ensure continuity of partnership and collaboration with the CISSS of Laval and all referral partners.

 

• CONTINUOUS PALLIATIVE SEDATION

• CONDITIONS

Article 24 of the Act provides that “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.” It is also specified that “the competent professional 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.”

The continuous palliative sedation can be offered to the patient, or to the person responsible for their substituted consent in the event of the patient’s incapacity, if the doctor deems this care to be indicated and reasonable.

Continuous palliative sedation is prescribed, administered and monitored in accordance with the standards of practice established by the Collège des médecins du Québec (CMQ) in collaboration with la Société québécoise des médecins de soins palliatifs (SQMDSP). The prescribing doctor must ensure that the patient meets the criteria for continuous palliative sedation before starting the procedure.

The doctor on duty checks daily to ensure that continuous palliative sedation is proceeding properly. Loved ones are met periodically to explain current and expected developments in the patient’s condition, as they would be for a patient who is not receiving it.

• CONSENT

Consent to continuous palliative sedation must be given in writing using the form prescribed by the Minister and kept in the person’s medical record, as provided for in article 24 of the Act. 

• DOCTOR’S DECLARATION NOTIFICATION AND RECORD-KEEPING

The doctor who provides the continuous palliative sedation at La Maison de la Sérénité must inform the CMQ within ten (10) days following its administration, as mentioned in article 34 of the Act and use the form provided for this purpose.

The medical notes and the declaration form regarding continuous palliative sedation are kept in the patient’s medical file at La Maison de la Sérénité.

• ACCOUNTING OF CASES OF CONTINUOUS PALLIATIVE SEDATION

The continuous palliative sedation must be accounted for to compile statistics and to review files. The Nursing Care Coordinator is responsible for keeping the count up to date. 

 

• MEDICAL ASSISTANCE IN DYING

• PREAMBLE

Despite benefiting from top-quality palliative care at La Maison de la Sérénité, patients sometimes choose to end their lives before the natural course of their illness for reasons of their own. Medical assistance in dying is then a treatment that can be administered at La Maison de la Sérénité. This treatment consists of administering medication to a person at the end of life, at their request, which leads to their death in the minutes that follow. This is a medical act strictly governed by law. 

La Maison de la Sérénité‘s mission is to provide free services to adult end-of-life patients so they may pass on peacefully while receiving quality palliative care, supported by a caregiving team and surrounded by their loved ones, in a quiet and welcoming environment. 

Responsibility for administering medical assistance in dying will be assumed by one of the doctors practising at La Maison de la Sérénité. This means that if the first evaluation of a person wanting to be admitted was performed by a doctor not practising at La Maison de la Sérénité, it will have to be redone. If the patient desires to receive medical assistance in dying from a doctor who does not practise at La Maison de la Sérénité, they will not be admitted.

 

• CONDITIONS

To receive medical assistance in dying, the person must meet all the eligibility requirements set out in Article 26 of the Act respecting end-of-life care, i.e.: 

1. Be of full age and capable of giving consent to care, subject to the exception provided for in the third paragraph of Article 29 with regard to the patient’s capacity.
2. Be an insured person within the meaning of the Health Insurance Act (chapter A-29).
3. Suffer from a serious and incurable illness and be in a medical state of advanced, irreversible decline in capability.
4. Experience enduring and unbearable physical or psychological suffering that cannot be relieved under conditions the patient considers tolerable.

 

According to the Act to amend the Criminal Code and make amendments to other related laws (medical assistance in dying) (S.C. 2016, c. 3), the person must also meet the following criteria to receive medical assistance in dying: 

1. a) they are eligible for health services funded by the government in Canada.
2. b) they are at least 18 years of age and capable of making decisions about their health.
3. c) they have a grievous and irremediable medical condition.

A person has a grievous and irremediable medical condition only if they meet all of the following criteria: 

• They have a serious and incurable illness, disease or disability.
• They are in an advanced state of irreversible decline in capability.
• That illness, disease or disability or that state of decline causes them to endure physical or psychological suffering that is intolerable to them and that cannot be relieved under conditions that they consider acceptable.
• Their natural death has become reasonably foreseeable, taking into account all of their medical circumstances, without a prognosis necessarily having been made as to the specific length of time that they have remaining.

1. d) they have made a voluntary request for medical assistance in dying that, in particular, was not made as a result of external pressure.
2. e) they give informed consent to receive medical assistance in dying after having been informed of the means that are available to relieve their suffering, including palliative care.

 

• CONSENT 

The person must make a voluntary and informed request for medical assistance in dying using the form prescribed by the Minister. This form must be dated and signed by that person.

The person may, at any time and by any means, including verbally, withdraw their request or ask to postpone the administration of medical assistance in dying.

All information and documents related to the request for medical assistance in dying must be entered in the person’s file, whether or not the doctor administers it, including the form requesting medical assistance in dying, the reasons for the doctor’s decision and, where applicable, the opinion of the doctor consulted. A record must also be kept of the person’s decision to withdraw their request for medical assistance in dying or to postpone its administration, as well as the reasons for doing so. 

• PROCEDURE

The procedure regarding requests for medical assistance in dying of La Maison de la Sérénité is compliant and based on the law, on the Collège des Médecins du Québec practical guide and on the Criminal Code.

You need to:

• Fill out the official “Request for medical assistance in dying” form.
• Fill out the “complementary form to medical assistance in dying request” form, requested by the interdisciplinary support group of the CISSS of Laval.
• Fill Out the form “Premier avis médecin prestataire selon les critères d’admissibilité à l’aide médicale à mourir (AMM)” (Opinion 1) using Saphir information software or in writing.
• Fill out the form “Avis du second médecin consulté sur le respect des conditions pour obtenir l’aide médicale à mourir” (Opinion 2) in writing.
• If final consent is waived, the doctor must conclude a formal agreement with the person at the end of life, using the form: “Aide médicale à mourir pour une personne en fin de vie consentement en cas de perte d’aptitude.”

This amendment allows a person at the end of life who has met all the requirements for receiving medical assistance in dying who subsequently becomes incapacitated to receive medical assistance in dying, provided that while they were at the end of life, they were determined to be eligible for it and before they became incapacitated to consent to care.

• Decide when medical assistance in dying will be provided, respecting the time limits prescribed by law.

Evaluating doctors

The doctor who receives the request for medical assistance in dying is obliged to comply with this request. They must, in all cases, notify the interdisciplinary support group, promptly so that the request can be followed up (whether or not they agree to act as the evaluating doctor). The doctor who receives the request must then inform the patient and the interdisciplinary support group of their role in the medical assistance in the dying process. Several options are available:

1st medical evaluator:

The doctor who performs the initial evaluation (Opinion 1) notifies the patient and the interdisciplinary support group of their conclusions. The doctor, who is part of the medical team of La Maison de la Sérénité, is then responsible for administering medical assistance in dying.

 

2nd medical evaluator:

The doctor who receives the request may not wish to administer medical assistance in dying but may participate in the second evaluation if the person meets the requirements. They must identify a doctor who will act as the first medical evaluator. Then, this doctor must notify the patient and the interdisciplinary support group of their availability to act as 2nd medical evaluator. They will have to fill out the “Avis du second médecin consulté sur le respect des conditions pour obtenir l’aide médicale à mourir” form and file it.

Before administering medical assistance in dying, the doctor must ensure the following:

• The patient’s request is voluntary and not the result of external pressure.
• The patient’s request is informed, by providing information on the prognosis of the disease, possible therapeutic options and their consequences.
• Of the persistent suffering of the patient and their repeated wish to obtain medical assistance in dying, by conducting interviews with the patient at different times, separated by a reasonable period of time, taking into account the evolution of the patient’s condition.
• To discuss the request with members of the interdisciplinary team in contact with the patient.
• The patient speaks to his/her family and/or the people they wish to contact to inform them of their decision.

• ADMINISTERING MEDICAL ASSISTANCE IN DYING

The 1st medical evaluator agrees with the patient on the date and time of administration of medical assistance in dying which will be administered in the patient’s room at La Maison de la Sérénité.

The doctor is responsible for obtaining medication they have prescribed from the hospital pharmacy at La Cité de La Santé of Laval. He or she is also responsible for returning the medication to the same pharmacy after administration.

The doctor administering the medical assistance in dying is responsible, with the help of the care coordinator, for ensuring that two intravenous lines are available and permeable at the time the medical assistance in dying is administered. Reasonable means must be taken to this end.

La Maison offers medical assistance in dying care and provides the necessary nursing and psychosocial care at the time it is administered.

• DOCTOR’S NOTICE DECLARATION 

The doctor who administers medical assistance in dying at La Maison de la Sérénité must, within ten (10) days of its administration, notify the CMQ and La Commission sur les soins de fin de vie.

• CASES OF CONSCIENTIOUS OBJECTION 

Conscientious objection is a personal act of refusal to perform certain acts that go against religious, moral or ethical imperatives dictated by one’s conscience. 

1. A doctor 

Any doctor practicing at La Maison de la Sérénité and who does not wish to participate in the process relating to a request for medical assistance in dying for a reason not based on Article 29 of the Act must, as soon as possible, notify the medical director of La Maison de la Sérénité and, if applicable, forward the request form for medical assistance in dying provided to the patient. The medical director, with the help of the interdisciplinary support group, must then take the necessary steps to find, as soon as possible, a doctor who agrees to process the request in accordance with Article 29 of the Act.

1. Other health professionals

Any professional may refuse to participate in the administration of medical assistance in dying because of his or her personal convictions. The professional must nevertheless ensure continuity of care for the patient, in accordance with legal provisions, the institution’s provisions, the provisions of its code of ethics and the patient’s wishes. The professional must notify the care coordinator, who will arrange for the patient to be cared for by another member of the nursing team.

• ADVANCE MEDICAL DIRECTIVES

Any person of legal age who is capable of consenting to treatment can indicate their wishes ahead of time by making advance medical directives if they become incapable of consenting to treatment. They may do so by a notarial act or in the presence of witnesses, using the form prescribed by the Minister. 

• CONDITIONS

• Advance medical directives apply only in cases of incapacity to consent to treatment.
• The form restricts advance medical directives to specific clinical situations that are not experienced at La Maison de la Sérénité, except for the do-not-resuscitate request.

 

• Advance medical directives can be filed with the Registre des directives médicales anticipées or placed in the medical file by a healthcare professional.

• CONSENT 

Advance medical directives have the same value as wishes expressed by the person. Medical directives are binding, meaning that healthcare professionals who have access to them are obliged to respect them in specific clinical situations.

 

• POLICY DISSEMINATION PROCEDURES 

The purpose of this section is to clarify the communication mechanisms put in place by La Maison de la Sérénité to demonstrate its concern for the transmission of relevant information.

The information must be passed on to the professionals, employees and volunteers of La Maison de la Sérénité, as well as to people at the end of life and their loved ones, in clear language, so that they are aware of their rights, duties and the services offered.

The information must be accessible. Clear and effective communication has a major impact. The means of communication used by General Management can be, as required, the following: 

• Periodic meetings. 
• Policies repository and procedures at the nurses’ station. 
• Internet (including social media). 
• Contact persons if needed.

 

August 22, 2024