I'm just referring to the recent report of the Quebec National Assembly special commission. It contains I think the very basis of how we should consider advance directives to be included in the medical assistance in dying act.
The current position of the Select Committee on the Evolution of the Act Respecting End-of-Life Care in Quebec is that advanced directives should be reserved for patients who have been newly diagnosed with a cognitive neurodegenerative disease, such as Alzheimer's, and not in any other situation.
I think it's important to set the context. Doing this allows doctors who make a diagnosis of Alzheimer's in a patient to explain in detail what's going on, what the nature of the disease is, what's ahead, what the treatment options are, and so on.
The patient is then able to make an informed decision as to whether they want to risk one day becoming unable to decide their fate and spending the rest of their life in that situation, that kind of agony. This would allow doctors to have advance medical directives that are truly detailed and personalized when they are called upon, 10 years later, to carry out an advance request for medical assistance in dying for a patient who probably won't remember making it. Moreover, the patient would be unable to communicate with the doctor because the dementia would be well established.
It is imperative that the physician be able to rely on advance medical directives that truly reflect the patient's wishes, especially from the perspective of their existential suffering.