As far as the guidelines are concerned, in fact, the Quebec Commission spéciale sur l’évolution de la Loi concernant les soins de fin de vie believes that the guidelines are adequate, if they are properly interpreted. In terms of operationalization, we have made a series of recommendations because that's where a lot of work needs to be done.
However, there is no doubt that great care must be taken when assessing the patient's personal history, particularly when assessing the likely irreversibility of the mental disorder. It is extremely important to take the time to do this, with the patient and with the family. A history of treatment, outcomes and periods of remission should be taken. For example, it should be determined how long the remissions lasted.
It's necessary to try to establish a kind of pain pathway or pain intensity, even if it's subjective. It's important to be able to estimate the intensity and permanence of the suffering experienced. The other thing that is absolutely fundamental is to ensure, as a society, that there is access to services and that access does not vary from region to region. We must also ensure the quality of services.
The guidelines provide for the services of competent professionals who will inform the person not only of their health problems—because they are often multiple—but also of the treatment options that are available.
The process also includes a reflection period. Consent is a process. In mental health, we have the time to do things properly. We have to look at all the guidelines. Competent professionals must be called upon to provide a proper assessment.
Since ambivalent patients aren't eligible, care must also be taken to ensure that the person's decision is persistent and consistent with their values. A desire for death must not be an expression of the disease or of one of its recurrences.