While the specific consultations for Bill 11 began this week, access to medical assistance in dying continues to generate debate and concern.
Some, such as the College of Physicians of Quebec (CMQ) and the Quebec Association for the Right to Die with Dignity (AQDMD), are of the opinion that access to medical assistance in dying should not be limited to people with neuromotor disabilities and that this qualifier should be removed.
Former Parti Québécois MP Véronique Hivon asked that parliamentarians show particular meticulousness in studying this issue given the broad definition of the term “disability”, and with good reason.
While acknowledging the benefits that medical assistance in dying can bring, particularly in terms of relieving suffering and respecting autonomy and human dignity, certain risks of expanding the availability of this care should not not be overlooked.
Indeed, although several guidelines are already provided to avoid abuses in the application of the law, fears remain as to the message that may be conveyed by the words chosen for the bill.
It is important to recognize that the term “disability” is not a consensus from a societal point of view and can be interpreted in different ways. The legal concept of disability, as defined in terms of discrimination, has, for example, evolved considerably over the past few decades. We would like to highlight the fact that, according to the Supreme Court of Canada, a disability can be real or perceived, and that “a person may have no limitations in everyday life except those created by the harm and the stereotypes1 “.
Thus, from a legal point of view, one cannot say, as argued by the Dr Georges L’Espérance, president of the AQDMD and neurosurgeon, that “every handicap comes from an illness”. This is the case of people whose weight can constitute a visible handicap in the eyes of society, even without an underlying disease.
We emphasize more particularly that it is necessary that the criteria for evaluating individual suffering are not biased by the weight of the persons. For what ? Because ambient fatphobia brings its share of suffering to fat people, suffering which is reflected in particular by harmful effects on mental health. Depression, anxiety and various psychological disorders, but also suicidal thoughts and actions are among the consequences of weight stigma.2
A lack of clarity in the guidelines around access to the medical assistance in dying program could thus open the door for psychologically vulnerable people to consider, or even avail themselves of, this medical assistance or, at least, to find some validation of their suicidal ideation. If we also add the fact that the medical profession is not spared from grossophobic biases3.4we find ourselves faced with a real risk that people stigmatized for their weight will have recourse to medical assistance in dying for suffering that is strictly discriminatory.
This is why we are in favor of clear guidelines, in order to avoid making “obesity” more morbid than ever.
1. Quebec (Commission des droits de la personne et des droits de la jeunesse) c. Montreal (City); Quebec (Commission des droits de la personne et des droits de la jeunesse) c. Boisbriand (Town), 2000 SCC 27
2. World Health Organization, WHO Regional Office for Europe. (2017). Weight bias and obesity stigma: considerations for the WHO European Region.
3. Foster, GD, Wadden, TA, Makris, AP, Davidson, D., Sanderson, RS, Allison, DB and Kessler, A. (2003), ‘Primary Care Physicians’ Attitudes about Obesity and Its Treatment’.
4. Neeru Gupta, Andrea Bombak, Ismael Foroughi and Natalie Riediger (2020), “Discrimination in the health care system among overweight adults: evidence from a Canadian national cross-sectional survey”.