UPDATE: The Quebec Court of Appeal ruled today that Bill 52 can go ahead
In 2013, Bill 52 – An Act respecting end-of-life care was introduced to the Quebec National Assembly. The purpose of the bill is to recognize the primacy of a person’s right to choose what kind of care he receives from health professionals including the right to end his suffering through medically assisted suicide. The Bill was adopted by the National Assembly which voted 94 in favor, 22 against. It came into force this month.
Under the new law, any adult capable of consenting to care can withdraw their consent or refuse to receive life-sustaining treatments or procedures and this refusal or withdrawal can be expressed by any means. The attending physician has to provide the person with all the information required particularly with regards to therapies and palliative care in order to allow them to make an informed decision and ensure that said decision is made freely.
Medical aid in dying can only be provided to adults in Quebec who qualify for medicare, suffer from a serious illness, are in an advanced state of irreversible decline, and suffer from “constant and unbearable physical or psychological pain which cannot be relieved in a manner the person deems tolerable.” The consent can only be provided by the person suffering in a free and informed manner and has to be done via a form that will be prescribed by the Quebec Health Minister. It has to be signed in the presence of a health or social service professional who also has to sign it.
Before the doctor administers the aid in dying, he has to agree that the person meets all the medical requirements and has to make sure that the request was made “freely and without any external pressure” and that the decision is an informed one. The doctor doesn’t have to discuss the patient’s decision with his close relatives unless the patient asks him to. If the physician decides all those criteria are met, he must then consult with a second doctor who is independent of the patient and himself in order to make sure the patient meets the medical requirements for assisted suicide.
If all this checks out, the doctor must then administer the aid personally and take care of the patient until death. The patient can withdraw their request at any time, and doctors are allowed to opt out of administering said aid, in which case the director of professional services must find another doctor to do it.
Though the Act has passed the legislature and received royal assent, the law is facing legal challenges by opponents concerned about the ramifications of medically assisted suicide. Though the law affects only Quebec, the issue has become a national one. In February 2015 the Supreme Court of Canada in Carter v. Canada (Attorney General) ruled the articles in the Criminal Code prohibiting medically assisted suicide unconstitutional and struck them down.
The Criminal Code states that no one can “consent to having death inflicted on him” and that such consent does not negate the criminal responsibility of the person who killed the consenting individual. Killing a person even with their consent would be considered a homicide and would result in a prison sentence of up to 14 years.
While the Supreme Court agreed that the purpose of the ban on medically assisted suicide – to prevent the abuse of vulnerable people, namely, the ill and weak – is a noble one, the ban also unfairly punished those of sound mind who suffer unbearably and want to end their pain. It leaves the latter in an awkward position of having to take their own lives by their own means, or suffer the debilitating agony of their illness.
The court gave the Federal Government one year to come up with new legislation. That delay expires February 6, 2016 and the Federal Government has since requested a six month extension. In the meantime, the articles in the Criminal Code remain in effect, though Quebec Justice Minister Stéphane Vallée has assured physicians that instructions would be given to prosecutors not to go after doctors offering end of life care.
The most vocal opponents of Bill 52 are Paul Saba, head of the Coalition of Physicians for Social Justice, and Lisa D’Amico, a woman with life threatening disabilities. Together, they went to the courts to prevent the law from going into effect.
A Superior Court ruling on December 1, 2015 suspended certain aspects of Bill 52 stating that they can’t come into effect so long as the Criminal Code articles are still in force. According to Saba, the law places undue emphasis on medically assisted suicide and not on palliative care.
Palliative care is the process by which medical and social service professionals make a patient as comfortable as possible in light of terminal illness and prepare the patient’s family for the impending loss.
Saba’s argument seems to be based on the notion that if palliative care was better, fewer patients would want to die. It unfortunately displays a remarkable lack of sensitivity towards the dying who value their dignity, are exhausted by their illness, sick of the side effects of pain medicines, and feel humiliated by the assistance they need for tasks as basic as wiping one’s ass.
D’Amico’s argument is as simple as calling medically assisted suicide murder. On December 9, 2015 she told CBC that “(M)urder should remain a murder. There’s no reason why a physician could be allowed to kill a person that is sick.”
Unfortunately for D’Amico, the Supreme Court of Canada said that medically assisted suicide isn’t murder, and that proper safeguards such as those that exist in countries like the Netherlands would be effective in order to prevent the abuse of the very people D’Amico is fighting to protect.
Most Canadians support medically assisted suicide, and that includes many of our terminally ill. It comes down to the issue of whether one can really choose to die. As history has proven countless times, people can, so why deny them the choice?