Quebec MAID Advance Request: How the DAAMM Works

What the DAAMM Is

Since October 30, 2024, Quebec residents with specific diagnoses can make an advance request for medical assistance in dying — called the demande anticipée d'aide médicale à mourir, or DAAMM. This is a standalone legal mechanism, completely separate from the DMA (advance medical directives) and the protection mandate.

The DAAMM allows a person who has been diagnosed with a serious, incurable disease that will inevitably lead to cognitive incapacity to specify the clinical symptoms that will trigger the administration of MAID once they can no longer consent. The most common qualifying condition is Alzheimer's disease and other forms of dementia, though other neurodegenerative disorders may also qualify.

This is the only province in Canada where advance MAID requests are legally permitted. It's also one of the most heavily regulated medical procedures in the country.

Who Is Eligible

The eligibility requirements are strict and intentionally narrow:

You must already have a medical diagnosis. The DAAMM is not available for healthy individuals planning ahead hypothetically. You need a confirmed clinical diagnosis of a serious, incurable disease that will inevitably lead to cognitive incapacity.

You must have full cognitive capacity at the time of the request. The process requires informed consent, which means you must be able to understand the nature of the request, its consequences, and the clinical triggers you're specifying. If cognitive decline has already progressed to the point where capacity is questionable, you cannot make a valid DAAMM.

The disease must be expected to cause cognitive incapacity. A terminal cancer diagnosis that will cause death before cognitive decline doesn't qualify for the advance request (though it may qualify for a regular MAID request). The DAAMM specifically addresses the scenario where disease progression will destroy your ability to consent before it becomes eligible for standard MAID administration.

How the Process Works

Step 1: Clinical consultation. You discuss the advance request with your attending physician or a specialized nurse practitioner (IPS). They confirm your diagnosis, assess your capacity to consent, and explain the process, alternatives, and implications.

Step 2: Drafting the request. The medical professional accesses a secure government portal in your presence. Together, you complete the request form, specifying the clinical triggers — the observable symptoms that will authorize the administration of MAID once you're incapacitated. Examples: failing to recognize immediate family members, inability to feed or dress yourself, or losing the ability to communicate meaningfully.

The trigger descriptions must be specific enough for a clinician to assess objectively. Vague formulations like "when my quality of life deteriorates" are not clinically actionable and will be rejected.

Step 3: Signing. You sign the digital form alongside the medical professional, two witnesses, and any named tiers de confiance (trusted persons). The witnesses cannot be your tiers de confiance, the medical professional assisting with the request, or anyone who would benefit from the administration of MAID.

Step 4: Registration. The completed request is uploaded to a centralized government registry managed by the Ministry of Health and Social Services (MSSS). Confirmation takes 5 to 10 business days.

Step 5: When triggers are met. When the clinical triggers described in your request are observed, the medical team initiates an evaluation process. Two independent practitioners must confirm that the triggers have been met and that administering MAID is appropriate. The procedure cannot be performed by a single physician acting alone.

The Cost

The process is free. Clinical consultations and assessments are covered under Quebec's provincial healthcare plan. There are no government filing fees.

The Federal Law Question

This is where the DAAMM gets legally complex. The federal Criminal Code of Canada governs MAID at the national level, and the federal law does not currently authorize advance requests. Quebec's healthcare legislation protects practitioners from provincial prosecution, but advance requests technically remain a homicide offence under the federal Criminal Code.

In practice, the DAAMM is operational in Quebec and regulated under provincial law. Physicians and nurse practitioners can administer MAID under a valid advance request following that provincial process. But some clinicians or institutions may still refuse to honour a valid request because of fear of federal criminal liability or institutional policy.

For families considering a DAAMM, the process is available today under Quebec law. Discuss with your physician whether they or their institution will honour an advance request — and, if not, ask about transfer-of-care to a willing practitioner.

What the DAAMM Does Not Replace

The DAAMM is not a substitute for any other advance planning document:

• It doesn't name a healthcare decision-maker — you still need a protection mandate for that
• It doesn't address treatment preferences for the five DMA interventions — you still need a registered DMA
• It doesn't cover financial or property management during incapacity
• It cannot be modified by your mandatary or any representative — only you can change it while capable

Completing a DAAMM should be part of a comprehensive advance care plan, not the entire plan. A protection mandate, a DMA, and a living will each serve distinct purposes that the DAAMM doesn't touch.

Modifying or Revoking a DAAMM

You can revoke or modify your DAAMM at any time while you still have mental capacity. To modify it, you complete an entirely new request through the same process — the new version automatically replaces the prior one in the registry.

You cannot make handwritten changes to an existing request. Any modification requires a new clinical consultation, a new form, and new signatures.

If you regain capacity temporarily — some conditions involve fluctuating cognitive states — your capable verbal statement overrides the advance request. A capable person's contemporaneous decision always takes precedence over any advance document.

How to Start

If you've received a qualifying diagnosis and want to explore an advance MAID request, the first step is a conversation with your physician or IPS. They can assess whether your diagnosis meets the criteria and walk you through the clinical and administrative requirements.

For the broader advance care planning process — including the protection mandate, DMA, and coordination tools that work alongside the DAAMM — the Quebec Advance Directive Kit provides step-by-step worksheets for the full Quebec civil law framework.

See more Quebec guides →