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Hot Topics in Health Innovation Policy

Quebec: Setting a Trend in Death with Dignity Legislation

February 01, 2013
Gabriela Prada Gabriela Prada
Director
Health, Innovation, Policy and Evaluation

In November of last year, I wrote a blog Do End-Of Life Decisions Belong to the Individual? noting how support for Death with Dignity legislation in Canada has been mounting, particularly in British Columbia and Quebec, and suggested that perhaps it was time for Canadian policy makers to revisit the law on this matter. Well, Quebec may be passing legislation to allow medically assisted end-of-life procedures as early as this summer. An expert legal panel released a 400-page report two weeks ago to the Quebec government recommending how to proceed with implementing this legislation.

What did it take to get to this point? 

  1. Many opinion polls in the province that found that a significant majority of the population was in favour of medically assisted end-of-life procedures; 
  2. An influential discussion paper by the Collège des médecins du Québec, which concluded that medically assisted end-of-life could be considered appropriate care under exceptional circumstances; 
  3. Polls conducted by physician group organizations revealing strong support for these measures among physicians; and 
  4. The work of a National Assembly committee (Dying with Dignity Committee), which undertook a vast consultation process. This involved submissions from 32 experts; public hearings in eight cities involving 239 individuals and organizations; open mic sessions with 114 individuals; 6,558 completed surveys; and over 16,000 submitted comments.

After this exhaustive consultation process, the Dying with Dignity Committee recommended allowing medically assisted end-of-life procedures for Quebecers who have terminal diseases and are suffering greatly. In response to the Committee’s recommendations, the government appointed three expert lawyers to make recommendations for the implementation of such legislation.

In Canada, medically assisted dying is prohibited by federal legislation (Criminal Code) and the federal government has fought any attempt to decriminalize assisted suicide. The legislation can’t be amended by any province. This has been a main obstacle in provincial efforts towards death with dignity legislation. However, Quebec policymakers are confident they would be able to put in place provincial legislation to allow end-of-life choices for Quebecers given that the province has jurisdiction over health care and professional qualifications of health professionals. In addition, the province is considering issuing a “directive to crown prosecutors to not enforce the part of the criminal code that bans doctor-assisted suicide, as long as a case fits the province's criteria”1.

The expert legal panel recommended that medically assisted end-of-life is granted only to individuals who meet the following criteria (as assessed by a physician)2:

  • A Quebec resident;
  • An adult able to consent to treatment under the law;
  • Request is made as an informed decision;
  • Suffering from a serious incurable disease;
  • In an advanced state of weakening capacities, with no chance of improvement;
  • Constant and unbearable physical and psychological suffering that cannot be eased under conditions deemed tolerable.

The expert legal panel also recommended many checks and balances to protect individuals: only patients themselves would be able to make a request; written requests would be submitted to two separate physicians (a 15-day period would be required between submissions), who would have to agree on their assessments; a panel of physicians would have to rule that the patient is competent and mentally sound to make his/her decisions; and there would be a registry and thorough documentation of these cases by Quebec’s physician body. In addition, three coroners would assess the patient’s file afterwards, and could forward the case to the police if anything suspicious were to be found.

Will Quebec be successful in passing Death with Dignity legislation? Quebec’s track record on other controversial files like abortion and same-sex marriage seem to indicate that it could indeed become the first province in Canada to allow medically assisted suicide, despite federal opposition. If this occurs, other provinces will likely follow.

Interesting Dying with Dignity Commission's Findings

1  CJAD Local News. http://www.cjad.com/CJADLocalNews/entry.aspx?BlogEntryID=10446337

2  Dying with Dignity Canada. News. Quebec One Step Closer, January 15, 2013. http://www.dyingwithdignity.ca/2013/01/15/quebec-one-step-closer-.php

 

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