A solid social consensus made Quebec the champion of medical assistance in dying (MAID) last year. With figures that now reach 5.1% of deaths, we are ahead of the Netherlands (4.8%) and Belgium (2.3%), where this practice has been established for longer. This progression occurs paradoxically while its expansion is stalling in Ottawa as in Quebec. These delays, if they do not plead in favor of any precipitation, call all the same for diligent examinations in 2023.
Announced shortly before the Christmas holidays, the Trudeau government’s decision to negotiate the postponement of MAID eligibility for people with mental illness is dividing the medical community. If some saw the arrival of the date of March 17, 2023 with growing apprehension, many rather deplored excessive caution. It is true that the gains will be essentially made on the organizational mechanics front.
However, as we know, the health network is so dysfunctional that it only advances through crisis from coast to coast. This reprieve therefore risks turning into a sterile haggling over time with, for the suffering patients who could have benefited from this expected way out, zero gains, or even denial of heartbreaking care.
It is worth remembering that the Expert Group on MAID and Mental Illness has expertly paved the way. We know what to do and we know how to do it. In Quebec, we also benefit from an additional advantage: MAID is offered from a continuum of care perspective in addition to benefiting from the enlightened supervision of the Commission on End-of-Life Care. It therefore comes with a tacit obligation: the quality and universality of palliative care must be irreproachable in order to guarantee, at all times and in all circumstances, the exceptional nature of assisted dying.
It will have to be the same with mental health care, poor relatives of a failing public system. MAID should never become a substitute for essential care that the state would otherwise fail to provide. The challenge here promises to be even more colossal: Canada’s spending in this area is up to half that of several OECD countries.
Moreover—the expert panel warned us—in mental health, providing the best care is not always enough. There is a spiral of vulnerability to take into account: poverty and housing, in the lead. We will have to tackle it if we don’t want this system to suffer from a problem similar to the one that is wreaking so much havoc in our public services, that is, the torn between several gears.
For now, all of Canada is holding its breath over the addition of this critical situation. But MAID should not be offered to some and not to others because we will not have been able to secure all the questions of incurability, irreversibility, capacity, the risk of suicide and the impact of structural vulnerabilities as prescribed by the expert group.
To this end, we are awaiting, and with great impatience, the keys that should be given to us by the final report of the Special Joint Committee on MAID, expected by February 17. All the same, the question of disabilities resulting in intolerable physical and psychological suffering will remain. Outside Quebec, this state of health is sufficient to have free access to MAID. Here, you must also be suffering from a serious and incurable disease. An asymmetry that the College of Physicians of Quebec rightly denounces.
In Quebec City, Bill 38 intended to add severe and incurable neuromotor disabilities to the list of eligible illnesses, a last-minute addition that undermined the work of the Health and Social Services Commission. It also opened the door to advance decisions and incapacity, in addition to extending its benefits to specialized nurse practitioners. His death on the soap opera, last June, was received as a bitter failure by all the players concerned, including among the most hesitant.
Rich in fourteen days of hearings, but above all in the words of a hundred experts and stakeholders, some 80 briefs and 3,000 opinions from the public, the examination of PL 38 had enabled a remarkable cross-partisan consensus. It is to be hoped that this good agreement will not have crumbled too much when the Minister for Health and Seniors, Sonia Bélanger, files a new version.
Above all, it is to be hoped that the CAQ government will tackle it as soon as parliamentary work resumes. The standardization of Quebec and Canadian laws governing MAID is essential. A multi-tier diet is unworthy of a dignified death for all approach. We have so far demonstrated exemplary humanity, ethics and scientific and medical probity. It is imperative to rigorously continue on this momentum, while taking care not to confuse prudence and procrastination in the turn.