With the tabling this week of Bill 11 on medical assistance in dying (MAID), Quebec continues a tradition of changes proposed on the basis of wise expertise and prudence, all for the good of those suffering and wishing to die with dignity. By broadening the eligibility criteria for this end-of-life care to people whose condition does not allow free consent at the very end of life, we are about to take a major and necessary step.
Since 2009, Quebec has been almost exemplary in terms of discussions and the development of laws governing access to MAID. The Minister for Health and Seniors, Sonia Bélanger, is following in this direction a path traced by solid precursors from other parties. She seems to want to maintain a line of non-partisanship in the continuation of the exchanges. It is healthy. Matters of life and death are above any political duel.
The clear guidelines and founding notions of respect and empathy specific to the law have encouraged the use of MAID by Quebecers. In 2021-2022, 5.1% of deaths in Quebec are associated with MAID, which now makes it a champion state in the world. Bill 11 corrects a major inequity. In fact, people suffering from a degenerative disease could not apply for marketing authorization because of the mandatory “end of life” criterion. This forced the applicants to be absolutely on the verge of death, which was purely impossible for these patients. This salutary correction is the logical and sensible follow-up to the judgment rendered in 2019 by the Superior Court of Quebec in response to the lawsuit led by Nicole Gladu and Jean Truchon.
Summoned by the Court to do so, Quebec therefore opens the door so that certain people overwhelmed by certain ailments — the list is not provided, but we spontaneously think of Alzheimer’s disease — can make an advance request for MA . Among other advances included in the bill, we also note the possibility for people with a serious neuromotor disorder to also be able to do so. This will, of course, have to be the subject of consultations and dialogue during the detailed study of the bill, but this matter is rich to study.
Much must also be made of the prohibition for all palliative care homes and private hospitals to refuse to provide MAID, which unfortunately still occurs in a minority of places. Minister Bélanger reported Thursday that very suffering patients still had to be transported by ambulance to a place where their request will be granted, for lack of having obtained the green light where they were.
However, Quebec has closed a door that the College of Physicians of Quebec would have liked to open: that of access to MAID for people whose only condition is a mental disorder. The question is incredibly delicate and of rare complexity, whether one thinks only of the need to obtain informed consent when making such a crucial decision, or even of the importance of not substitute a request for MAID for suicidal thoughts. In the just-released second report of the Special Joint Committee on Physician-Assisted Dying — Medical Assistance in Dying in Canada: Choices for Canadians —, the federal government maintains that it is not ruling out this possibility, but it is asking for more time to carry out a detailed analysis. Ottawa announced just before the holidays that it would delay the expansion of the Canadian MAID regime, precisely to properly weigh the pros and cons surrounding this specific group of candidates.
Quebec is not ready to venture into this minefield. It therefore subscribes to the recommendation formulated in December 2021 by the Special Commission on the evolution of the Act concerning end-of-life care, which affirmed that it did not want to enter this field, and this, in the name of a precautionary principle. . “We believe that the risks associated with expanding access to physician-assisted dying for people whose only medical condition is a mental disorder would be too multifaceted and thus could not be tightly controlled,” the Commission wrote. The experience acquired in Quebec since 2009 has made it possible to understand that time and reflection sometimes change perspectives, even on seemingly unfathomable ethical questions. That may be the case here too.
That all this debate surrounding medical aid in dying does not deprive us of thinking of all the others, all those who will not choose MAID as a way out, but who should have the right to quality palliative care and easy to obtain. The tragic end of Andrée Simard, widow of former Prime Minister Robert Bourassa — who died after three days of terrible suffering without having had access to palliative sedation, which was in demand — is unfortunate proof that this crucial sector of health care end of life should not be neglected in terms of resources. It is also a question of dignity.