Quebec set to legalise medical aid in dying

Quebec appears poised to legalise medically-assisted suicide, or euthanasia, as a law is expected to be voted on later this month, making the francophone province the first in Canada to allow the controversial practice.

Known as “An act respecting end-of-life care”, Quebec’s Bill 52 would permit physicians to administer “medical aid in dying” to patients in their care.

“It’s really about this idea of having a continuum in care. Medical aid in dying is something that will be very exceptional, for exceptional circumstances of exceptional suffering,” Véronique Hivon, the Quebec Minister for Social Services and Youth Protection that introduced the bill, told Al Jazeera.

“The most important thing, of course, is to be able to provide very good palliative care. In this bill, we provide for the obligation for all of the public health organisations in Quebec to have a policy and a programme of palliative, end-of-life care, and a broad training,” she said.

The federal government has said that it will not change the criminal code to accommodate Quebec.

When Bill 52 was first tabled last June, Canada’s Minister of Justice and Attorney General, Rob Nicholson, said he would review the implications of the law, and renewed his support for the country’s existing restrictions on euthanasia.

MNA Veronique Hivon says Bill 52 will only be applied in “exceptional circumstances of exceptional suffering”.

“In April 2010, a large majority of Parliamentarians voted not to change these laws, which is an expression of democratic will on this topic,” he said in a statement.

Still, Quebec argues that its version of medical aid in dying is a health issue, and as such, falls under its provincial controls.

“We have had no sign from the federal government saying that they intend to challenge this bill. They say for now that they don’t intend to change the criminal code, but our approach doesn’t need such a change because it’s based on our jurisdiction,” Hivon said.

Restricted eligibility

To be eligible for medical aid in dying in Quebec under Bill 52, a person must be over 18-years-old, suffer from an incurable illness that is in an advanced state of irreversible decline, be in constant and unbearable pain, be insured under the Health Insurance Act, and most importantly, be able to give his or her full consent to a doctor in writing.

When presented with such a demand, doctors must request the second opinion of another physician, confirming that the patient meets all the requirements.

Medical practitioners that disagree with Bill 52 on moral grounds will be allowed to refuse administering medical aid in dying. They must inform their health institution of the decision, and that institution will then find another doctor to carry out the procedure.

“I am very satisfied with all the guidelines that are very strict. [They] are provided to ensure the respect of the wishes of the people at the end of their life, and also the pre-act and post-act oversight that is planned and will be enforced in the law,” Raymonde Saint-Germain, Quebec’s ombudsman, told Al Jazeera.

“The precautions [are there] to be sure that the will of the person will be respected, but that this will is of full consent and exhaustive comprehension,” she explained.

Still, not everyone is convinced that enough safeguards are in place under Bill 52.

“We believe that the risk to vulnerable groups, like people who are elderly or people with disabilities, are huge,” Nicolas Steenhout, Director General of anti-euthanasia group Living with Dignity, told Al Jazeera.

He said that only a fifth of Quebeckers currently have access to proper end-of-life care, and that the government should invest in better palliative care services for patients and their families, rather than medical aid in dying.

“On the one hand, we’re not providing care. On the other hand, we’re saying we’re going to help you die. It’s wrong,” Steenhout said.

The Palliative Care Network of Quebec (RSPQ) has also come out against the legislation, saying Bill 52 “will create confusion and suffering for families of patients and palliative care professionals”.

“We are deeply concerned that this bill tries to introduce euthanasia in veiled terms by giving it a new name and incorporating it to the world of palliative care,” Alberte Déry, president of the RSPQ, said.

The Anglican Church in Quebec has also expressed its opposition to doctor-assisted suicide.

“Such a notion asks our physicians to transform from ministers of healing to agents of death,” the chief Anglican Reverends of Quebec City and Montreal, Dennis Drainville and Barry B Clarke, wrote in a letter to the Montreal Gazette newspaper.

“Both the request for assistance in committing suicide, and the provision of such assistance, must be taken seriously as a failure of human community,” they stated.

Canadian debate

According to an opinion poll released last fall by the Toronto-based Environics Institute, seven in 10 Canadians approved of euthanasia, defined as “allowing a terminally ill or severely disabled person to end their life”.

In Quebec, support for euthanasia jumped by 10 percent since 2004. In general, Quebeckers back euthanasia more than most Canadians, with 79 percent in favour in 2013, second only to British Columbia, where 80 percent of people support it.

The country’s approval rating for euthanasia in 2013 was the highest in the past 20 years, when the high-profile case of a BC woman captured national headlines.

Sue Rodriguez was suffering from amyotrophic lateral sclerosis (also known as Lou Gehrig’s disease, or ALS) when she wanted to end her life with a doctor’s help. After two provincial courts rejected her request, the case was heard by the Supreme Court of Canada in 1993.

The Court eventually ruled, in a 5-4 decision, that Rodriguez had no right to doctor-assisted suicide, and upheld section 241b of the criminal code.

Today, the case of another BC woman is once again challenging Canada’s ban on euthanasia. The case of Kay Carter – whose family brought her to Switzerland to receive medical aid in dying in 2010 – led to a challenge of Canada’s ban on doctor-assisted death.

That case is expected to be heard next fall.

“What we have here are two totally different approaches to the idea of medical aid to die,” Francoise Hebert, a board member of Dying with Dignity, a group that supports medically-assisted suicide, told Al Jazeera.

“The first one is Quebec, which is totally reframing this issue as a healthcare issue… Whereas the Carter case is approaching it from the perspective of the rights of the individual, and the autonomy of the body,” she said.

Setting a precedent

There are currently only a few jurisdictions worldwide where some form of euthanasia is legal: Belgium, Luxembourg, the Netherlands, and in a handful of American states (Oregon, Washington, Vermont and New Mexico).

Belgium is expected to extend the right to die to terminally-ill minors as young as 12-years-old.

In February, Belgium is expected to pass the first law in the world that would extend the right to die to terminally-ill minors as young as 12.

The Quebec National Assembly is expected to vote on Bill 52 later this month, as the National Assembly session started again this week. Provincial legislators will be allowed to forego party lines and vote with their conscience, and the law is expected to pass.

The bill may lead the way for other provinces across Canada to adopt similar legislation, Hebert said.

“If Quebec passes this law, and the federal government doesn’t challenge Quebec on it… then I think that BC will come on shortly. And I know that Ontario is thinking about it,” she said.

“It may be that this reframing of this issue as a healthcare issue rather than a criminal issue was that spark that we need in this country.”