Quebec introduces bill that includes expanded consent to euthanasia

The Quebec government has introduced a bill that would allow people to give their prior consent to medical assistance when dying if they have Alzheimer's or another disease that would render them legally unable to give informed consent later.  (Ben Nelms/CBC - photo credit)

The Quebec government has introduced a bill that would allow people to give their prior consent to medical assistance when dying if they have Alzheimer’s or another disease that would render them legally unable to give informed consent later. (Ben Nelms/CBC – photo credit)

Quebec lawmakers have introduced legislation that, if passed, will expand medical assistance in dying (MAID) and allow people to ask for it before a terminal illness disables them.

Bill 11, tabled Thursday by Sonia Bélanger, the minister responsible for senior citizens, amends the End-of-Life Care Act to allow people to apply for MAID early.

“MAID is end-of-life care and I emphasize the word ‘care’. It’s caring that allows people to live their final moments the way they want to,” Bélanger said at an afternoon news conference in Quebec City.

“The measures presented in this bill have been thought through and supported by the opinions of citizens and experts, and we have the opportunity to continue our reflections accompanied by various groups that will come to present their positions.”

If passed, it will allow people suffering from degenerative diseases such as Alzheimer’s to apply for MAID and receive early consent.

In the spring of 2022, lawmakers had proposed changes to Quebec’s MAID framework to allow for expanded consent, but they decided at the time to postpone legislative changes as more discussion was needed.

In its current form, Bill 11 would establish a set of guidelines by which an individual may make a pre-enquiry for MAID. They must be suffering from a serious and incurable illness or, if the law is passed, a “severe and incurable neuromotor disability”.

They must then submit a free and informed application – notarized or made in the presence of witnesses – describing the level of suffering they no longer wish to tolerate.

Once the patient is incapacitated by their illness, two professionals would need to agree that the patient would experience the level of suffering they described in their application before MAID can be administered.

Accordingly, a patient who is capable of giving consent can withdraw his application for an advance payment at any time.

Bill 11 would also require palliative care hospices to offer MAID. Not all palliative care hospices currently offer it, which Bélanger says is forcing some Quebecers to take ambulances to facilities where they can receive the procedure.

The bill would expand the end-of-life care that specialty nurses can provide, allowing them to administer “continuous palliative sedation” throughout the end of life.

Quebec law does not extend MAID to people with mental disorders such as depression, stating that “a mental disorder is not considered an illness”.

Bélanger said that consultations with medical professionals, the public and stakeholders failed to develop a consensus on including mental disorders in MAID legislation, so Quebec is excluding them.

Before the bill can be passed, a consultation process takes place.

Marc Tanguay, the interim leader of the Quebec Liberal Party, said his party will allow its MNAs to freely vote on the bill at their conscience and he expects an important, impartial discussion before a vote.

“We must work diligently but seriously so that the law is clear and applied consistently throughout Quebec,” he said.

The Quebec Association for the Right to Die with Dignity hailed the law as a step forward for patients’ rights.

“Thanks to advance inquiries, people affected by a cognitive neurodegenerative disease can decide on medical euthanasia at a later date. This change offers them a peaceful end to life,” says Dr. Georges L’Espérance, the association’s president and a MAID practitioner, said in a statement.

On Wednesday, Living with Dignity, a group that opposes MAID and advocates improved medical and palliative care in place of the procedure, posted a message on social media opposing the expansion of MAID in Quebec.

“We hope that the forthcoming debates will also highlight the many pitfalls of medically assisted dying of incapacitated persons, even upon prior request,” the organization wrote, adding that there are “major ethical issues that warrant full deliberation in the parliamentary committee.” earn”.

The federal government legalized MAID in June 2016 — after Quebec had already done so — but initially only those whose deaths were “reasonably foreseeable” qualified. This essentially limited MAID to people with terminal illnesses who were nearing the end of their lives.

In October 2020, the federal government expanded the law, removing the requirement of reasonably foreseeable deaths. The amendment allowed people with “serious and terminal illness, disease or disability [excluding mental illness, for now]” to qualify for MAID.

Patients must also be in an “advanced state of irreversible decline in performance” and endure intolerable suffering “that cannot be relieved under conditions the person finds acceptable”.

Provinces and territories have their own regulations and guidelines for implementing MAID.

Currently, Quebec law requires that an individual be able to provide informed consent at the time of receiving MAID, which excludes individuals with degenerative diseases, including Alzheimer’s disease.

In December 2021, a bipartisan committee recommended that adults in Quebec who have been diagnosed with terminal and incapacitating illnesses may apply for MAID early before their illness renders them incapacitated.

Canadians whose sole medical condition is a mental illness, such as depression or a personality disorder, are scheduled to be eligible for MAID under federal rules in March 2024. Such requests were originally set to be legalized later this year, but Attorney General David Lametti said a delay was necessary to allow the medical community to prepare for the complexity of these cases.

Between April 2021 and March 2022, 5.1 percent of Quebec deaths were due to MAID.

But the latest figures from Radio-Canada show the number is growing: Up to seven percent of all deaths in Quebec are now the result of MAID. The figure cements Quebec as the jurisdiction with more medically-assisted deaths per capita than anywhere else in the world.


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