The Collège des médecins du Québec is advocating for people with a mental health disorder to request medical assistance in dying. In an opinion adopted on Friday, the professional order also opens the door to the admissibility of certain children. But for these two categories of patients, clear guidelines would frame the practice.
The opinion states that “MAID can be an appropriate care in the cases of babies under the age of 1 year, victims of extreme suffering which cannot be relieved, coupled with very poor prognoses, and affected by severe malformations or serious polysymptomatic syndromes, which destroy any prospect of survival ”. In these very rare cases, the parents would be stakeholders in the decision, which would be framed by a “strict protocol”, as in the Netherlands, explains the president of the College of Physicians of Quebec, Dr.r Mauril Gaudreault.
There are cases where it is dramatic during the first months of life. We agree that it can be exceptional. But for us, even in exceptional cases like this, it is a care that should be considered for all patients. Suffering touches these little babies who suffer without being able to tell.
The Dr Mauril Gaudreault, President of the College of Physicians of Quebec
The College also believes that “mature minors”, ie children between the ages of 14 and 17, should be eligible, under certain conditions, for MAID. These young people could consent to it “jointly with parental authority”, according to Dr Gaudreault, who speaks, for example, of young people who have lived since birth with chronic diseases and who have spent more than half of their life in hospital. “The College supports its position on the fact that suffering does not take age into account and that in minors, it can be as intolerable as in adults”, indicates the College in its opinion.
Before making this recommendation, the professional order set up a think tank that consulted the population and its members through surveys, briefs and focus groups during the past year, explains Dr.r Gaudreault.
Neurocognitive disorders: for anticipated requests
The College of Physicians – which had already made known its support for this expansion during the special commission that looked into the issue in Quebec – also believes that people with neurocognitive disorders, such as Alzheimer’s disease or Parkinson’s disease, should be able to seek medical assistance in dying if they so choose. They should, however, have made the request with advance directives, shortly after obtaining their diagnosis, when they are able to give their consent. “A very large majority of the population and of physicians support this openness,” says Dr.r Gaudreault.
This position is consistent with that of the Special Commission on the Evolution of Act respecting end-of-life care, who said Wednesday was in favor of extending the law to incapacitated people, such as those with Alzheimer’s disease.
Don’t rule out mental illness
The College of Physicians stands out from the Special Commission with regard to people whose only medical problem is a mental disorder. For the Special Commission, “there is no consensus among health professionals as to the incurability of mental disorders” and their irreversibility. The extension of the MA for this group of patients is therefore not supported.
A position criticized by the Association of intervention groups for the defense of mental health rights in Quebec (AGIDD-SMQ). In a press release published Thursday, the AGIDD-SMQ considers the position of the Special Commission “unjust and discriminatory”. “Once again, the rights and suffering of people with mental health problems are not taken into account,” writes AGIDD-SMQ.
Unlike the Special Commission, the College of Physicians believes that patients with mental illness should be able to seek MAID.
There is a lot of talk about inappeasable suffering for physical disorders or neurocognitive disorders […] But for severe psychiatric disorders too, there may be uneasy suffering.
The Dr Mauril Gaudreault, President of the College of Physicians of Quebec
The latter explains that very few of these patients would be eligible for MAID. These should in particular be overdue for “several years”. And “clear and serious” guidelines should be established to guide clinicians in their decision. The College speaks in particular of “the suicidal ideation, registered in the symptomatology described of a mental disorder, which should be excluded”.
The Dr Gaudreault also specifies that “mental disorder” does not necessarily mean that the person is incapable of consenting to their care. He specifies that he is not in confrontation with the Special Commission. The College simply wants to “participate in the reflection” while Quebec is called upon to eventually expand its law. On Friday, François Legault also hinted that a bill in this direction would be tabled during the next session.
Medical assistance in dying has been administered in Quebec since 2014. To have access to it, a person must be able to give consent, have an incurable disease whose decline is advanced and irreversible and present intolerable suffering. A person suffering from a neurocognitive disorder cannot currently obtain MAID because he is incapable of consenting to it. The Special Commission was mandated to study this issue as well as that of access for people with mental disorders.
Currently, two laws govern medical assistance in dying in Quebec: the provincial law and the federal law. There are some differences between the two. The College of Physicians has been campaigning for months for these two laws to be “harmonized”. The federal government must make a public statement in 2022 on the expansion of its law on medical assistance in dying.