In Quebec, the request for early medical assistance in dying has a face: that of Sandra Demontigny.
Over the past few years, this courageous woman suffering from an early form of Alzheimer’s has spared no efforts to raise public awareness of her reality.
Its story has touched the population. She made people understand from the inside the reality of people who know that they are going to lose their cognitive capacities, and who wish to leave with dignity.
In its recent report, tabled on December 8, the Special Commission on the Evolution of Act respecting end-of-life care abounds in the sense of Mme Demontigny and recommends that the possibility of making an early request be granted to Quebecers. This recommendation is justified. Remember that in 2019, the Superior Court of Quebec recognized the discriminatory nature of the imminent end of life criterion when it comes to medical assistance in dying (MAID).
PHOTO ARCHIVES THE PRESS
Sandra Demontigny
The Commission makes several recommendations to properly manage this type of request: we must be suffering from a serious and incurable disease which will be accompanied by an advanced and irreversible decline in our capacities; it is necessary that our state involves physical or psychic suffering, “including existential, constant, unbearable” which cannot be appeased under conditions considered tolerable. These sufferings must be observed and validated by a doctor.
The Commission is also proposing that we entrust to a third party the responsibility of requesting MAID in the event that we are no longer able to do so. This point is particularly delicate and should be very well marked.
Finally, the Commission considers, like several organizations, including the College of Physicians, that specialist nurse practitioners must be allowed to administer MAID. This will make it more accessible in areas where doctors are rarer.
The 11 members of the Commission had to answer another difficult question: should medical assistance in dying be allowed to people whose only medical problem is a mental disorder? Here, the ice on which the Commission was operating was much thinner. The Association des médecins psychiatres du Québec and the Collège des médecins are in favor of this expansion. They represent professionals who, in their practice, face exceptional cases where mental illness causes constant and excruciating suffering. Very rare cases, they said.
But the members of the Commission had no choice but to listen to the concerns of other members of civil society, including the Quebec Association for Suicide Prevention.
The latter argued, quite rightly, that such a decision would have a terrible impact on people with mental health problems who have thoughts of suicide.
She even fears “a modification of the Quebec social norm relating to suicide, bringing it towards more acceptability, even a certain trivialization”.
Faced with a situation filled with gray areas, where opinions diverge a lot, where the notion of incurable disease is not clear among specialists, the Commission has therefore exercised caution. She does not deny the suffering that these seriously ill can feel, but does not recommend allowing them to seek medical assistance in dying. The Commission is right not to want to open this door for the moment. We salute his prudence and ask the Minister of Health, Christian Dubé, to be sensitive to it when he changes the law.
This is an admirable aspect of this Transpartisan Commission which does not get ahead of Quebec society, but sticks to it. It reflects collective reflection, careful not to upset the values of Quebeckers.
In its recommendations concerning the expansion of the law, the College of Physicians however opens the door to a discussion that goes much further and that departs from the Quebec approach which is part of a logic of continuum of care. .
The College mentions the possibility of authorizing medical aid in dying to those who experience “fatigue of living”. In other words, we are talking about assisted suicide here.
“The College is sensitive to the situation of the elderly who are not strictly speaking in an end-of-life context, it is written, but who clearly express their desire to put an end to their existence, no longer having any interest to continue. To realize their will, these people currently have no other choice than passive suicide through voluntary malnutrition and dehydration. ”
As complex and delicate as it is, this question will arise more and more in the coming years. With the accelerating aging of the population, one might think that many families will have this difficult conversation. The College of Physicians is right to mention it, even if we believe that this possibility should be approached with great caution. This important discussion should not be guided by the current state of our health care system, the shortage of personnel and the under-capacity of our establishments.
It is to be hoped that the Commission will always be there, with the same depth and the same benevolence, to accompany us in this reflection.