CBC
Thu, October 24, 2024
Sonia Bélanger, Quebec's minister responsible for seniors, says the province won't wait for Ottawa in making changes to medical assistance in dying. (Jacques Boissinot/The Canadian Press - image credit)
Quebec is going ahead with its plan to authorize early requests for medical assistance in dying, despite concerns raised by the federal government.
Starting Oct. 30, the province will begin accepting requests for assisted dying, known as MAID, before a person's condition, such as Alzheimer's, renders them incapable of giving consent.
Health officials held a briefing for journalists early Thursday to outline how applications will be considered, and pointed to new online guidelines for patients and physicians.
Dr. Stéphane Bergeron, an assistant deputy health minister, said during the briefing that patients who could potentially be eligible will need to meet with doctors on multiple occasions to understand how it would work and when it would apply.
"It's something that will take a bit of time before this goes ahead," Bergeron said.
Ottawa says to 'wait'
The federal government has repeatedly expressed concern about Quebec moving forward with advanced consent before it modifies the Criminal Code.
Federal Health Minister Mark Holland told La Presse on Wednesday that Quebec should "wait" before going ahead.
In a follow-up statement to CBC News on Thursday, his office said the federal government "is taking the necessary time to examine the details of what the government of Quebec has announced."
"We are committed to working with Quebec — and all provinces and territories — to carefully consider next steps," the statement said.
Minister of Health Mark Holland rises during Question Period in the House of Commons on Parliament Hill in Ottawa on Thursday, Feb. 29, 2024.
Federal Health Minister Mark Holland says Quebec should wait for a broader discussion on MAID. (Justin Tang/The Canadian Press)
On Thursday, Sonia Bélanger, the minister responsible for seniors, said the province had conducted a "rigorous" assessment of how the new rules will be applied, and will move ahead without Ottawa.
"In the case of MAID, we have never waited for the federal government," she told reporters in Quebec City.
For more than a year, Quebec has been calling on the federal government to modify the Criminal Code to allow people to make such requests — and made it clear in August it would not wait any longer.
The provincial government adopted a law in June 2023 permitting people with serious and incurable illnesses, such as Alzheimer's disease, to ask for assisted dying while they have the capacity to provide consent, with the procedure being carried out after their condition has worsened.
The province has asked the Director of Criminal and Penal Prosecutions to respect the conditions laid out in the act respecting end-of-life care when it comes to pressing criminal charges.
A question of dignity
Georges L'Espérance, a retired neurosurgeon and head of the Quebec Association for the Right to Die with Dignity, doesn't believe there's a need to wait any longer.
"We have a lot of reports on that, and we have a lot of expertise on that," he said.
L'Espérance said said it will be up to patients and their families to determine at what stage they no longer want to live, and that could vary from person to person. For example, a person with Alzheimer's may decide they want MAID when they no longer recognize their family or can't feed themselves, he said.
"If you have that law, you know that you won't go in the last year of the disease, in the path when you lose all your dignity," he said.
Some health professionals remain opposed to the changes. Dr. Catherine Ferrier, an assistant professor in McGill University's department of family medicine and a member of the group Living with Dignity, has worked with patients with dementia for 40 years.
She said it will be difficult for a patient to know if they will want to die five years from now, or longer.
"There are many, many unknowns there," she said. "You don't know if you will be suffering."
Ferrier said the province should instead be focused on providing better care to patients with dementia.
"You're never undignified. You have the dignity of a person for your whole life," she said.
"I find it sad that in Quebec we're not providing all the supports that people need as they get older and more vulnerable and people lose their cognition, and then we're fast-tracking death."
Quebec says it's ready to start accepting advanced MAID requests as of Oct. 30
Morgan Lowrie
Thu, October 24, 2024
MONTREAL — Quebec's Health Department says it will be ready to meet the expected demand for advanced applications for medical assistance in dying when it begins accepting those requests next week.
Dr. Stéphane Bergeron, an associate deputy minister in the department, told reporters in a briefing on Thursday that it will take time for the first requests to be approved, which will give the health system further room to prepare.
"It's not something we do in a few minutes during one consultation or appointment," he said. "It's something we have to take our time with, that will certainly require several meetings between the (health professionals) and the patient."
On Oct. 30 Quebec will become the first province to allow a person with a serious and incurable illness to request that a medically assisted death be administered months or even years in the future — when their condition leaves them unable to consent to the procedure.
Quebec chose to expand its MAID program to help people with illnesses such as Alzheimer's — without waiting for Ottawa to update the Criminal Code. Instead, the province asked the Crown prosecutor's office not to charge doctors who choose to participate in the advanced MAID program as long they comply with the provincial act.
The Criminal Code says a health-care worker who administers a medically-assisted death must ensure that the person gives "express consent" immediately before they receive MAID. They must also offer an opportunity to withdraw the request. There are exceptions, but for the consent requirement to be waived under Canadian law, a person seeking MAID must fulfil several criteria, including that they entered an arrangement specifying the day on which they wanted to die.
Bergeron says that people who seek approval for advanced MAID applications must fulfil several obligations, including that they describe in detail the symptoms that health-care workers will need to witness before administering the procedure. They must also have a serious and incurable condition that causes them "constant and unbearable physical or psychological suffering."
To Quebec's displeasure, Ottawa has been relunctant to quickly update the Criminal Code to allow advanced MAID requests. Matthew Kronberg, spokesman for federal Health Minister Mark Holland, said Thursday in a statement that MAID is a "complex and deeply personal issue. Given this complexity, the Government of Canada is taking the necessary time to examine the details of what the Government of Quebec has announced. We are committed to working with Quebec – and all provinces and territories – to carefully consider next steps."
Bergeron said the province didn't have an estimate of how many requests the health network might receive in response to the expansion, for which he said there is a "strong consensus" in Quebec. Earlier this year, six professional orders, including those representing Quebec's doctors and nurses, put out a statement urging the federal government to amend the Criminal Code to allow for advanced requests.
On Thursday, Bergeron and two other doctors present at the briefing said Quebec's experience in delivering MAID would help them navigate the challenges presented by the new rules.
Health professionals, they said, would have to determine whether a patient who is agitated or uncooperative at the moment of assisted death was resisting because it's a common symptom of a neurocognitive illness or because they were refusing the MAID treatment.
Dr. David Lussier, director of a geriatric pain clinic at the McGill University Health Center, told the briefing that doctors who work with people who have dementia and Alzheimer's have techniques that help them calm patients who become agitated and resist treatments, including through mild sedation. Another doctor, Guy Morissette, said doctors would not use "very restrictive" techniques such as physical restraints, and could decide instead to put off the procedure while the patient is assessed further.
However, Dr. Catherine Ferrier, a doctor in the division of geriatrics at the McGill University Health Centre who objects to MAID, said she sees a number of "ethical and practical problems" with advance requests in particular.
People's wishes evolve as they go through a chronic illness, she said, making proper consent nearly impossible to obtain. The push for advanced requests is based partly on "stigma" and the assumption that people who have neurocognitive disorders are suffering and have no quality of life, she added, which is not necessarily the case.
"You don't know what your experience will be," she said.
Provincial data indicate that requests for MAID have grown every year since the law went into effect in December 2015. A recent report says that 5,717 people received MAID between April 1, 2023, and March 31 of this year, accounting for 7.3 per cent of the province's deaths during that period.
The number of doctors involved in administering MAID also rose 10 per cent in the same period, to 1,804, an increase the Quebec college of physicians described as "good news" given the demand. A spokesperson said in an email that the order expects the demand for MAID to continue to grow in response to the program's expansion.
This report by The Canadian Press was first published Oct. 24, 2024.
Morgan Lowrie, The Canadian Press
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