Levels of medical intervention ─ levels of care

Faced with a disparity in approaches to end-of-life care in Québec healthcare institutions, the Association médicale du Québec (AMQ) asked the Institut national d’excellence en santé et en services sociaux (INESSS) to establish a consensus on a unique scale of levels of medical intervention (LMI). In short, LMI designate the treatment preferences expressed by patients or their substitute decision-makers to their physicians, and are recorded in their medical charts. LMI are complementary but distinct from advance medical directives (AMD) addressed by Québec’s Loi concernant les soins de fin de vie of June 2014 (in English, the Act Respecting End-of-Life Care, AELC).

The objectives of this report are to gather scientific evidence on the effectiveness and safety of LMI; to identify the facilitators, barriers and expectations regarding LMI practices; to synthesize legal and ethical aspects of the concepts surrounding LMI; to document LMI practices in Québec; and to survey public knowledge of LMI and related concepts. This report is the first part of a project and aims to specify which product(s) will best respond to the needs of the Québec people regarding LMI. This project is separate from but complements the concurrent work of the committee appointed by the Ministère de la Santé et des Services Sociaux (MSSS) to implement the AELC.

Medical aid in dying, euthanasia, palliative sedation and clinical practices in end-of-life care and palliative care are excluded from this project.