For advanced directives, you might find me somewhat chauvinistic, but Quebec's proposals seem very reasonable to me. What's involved is designating a trusted relative, friend or substitute, to be responsible for alerting the care team of the patient's condition when it has reached the stage specified by the patient as when they wanted to receive medical assistance in dying. After that, the assessment would be carried out by the care team.
It's important never to forget that these patients are not being treated only by a doctor. They always have a care team consisting of a nurse, a social worker, etc. I can't see anything wrong with a wait time of three, four or five months to assess requests. There is nothing urgent when the family member says that his father or mother has reached the stage at which they had said they wanted to receive medical assistance in dying. The safeguard would be to plan for a period of time before doing an assessment.
The other problem is decision-making capacity. For a patient with a cognitive neurodegenerative disease, this capacity disappears all at once. They might reaffirm their desire for medical assistance in dying. It would be relatively easy to assess the patient's decision-making capacity every year or every two years, for example. As soon as the patient is deemed to be incapacitated, a formal assessment would be carried out by two doctors.