Quebec consultations begin on expanding medical assistance in dying

According to Statistics Canada, there were 5,631 cases of MAID reported in Canada in 2019. (file photo)

QUEBEC CITY — A committee at the Quebec National Assembly began new work Friday on possibly expanding medical assistance people who want to end their lives.

In 2014, Quebec enacted a law to offer medical assistance in dying (MAID) to people who fit within a certain category: patients of adult age, suffering from a serious and incurable illness, at the end of life, where their suffering was deemed intolerable.

The end-of-life criterion was eliminated in 2020 in response to a Superior Court ruling in favour of Nicole Gladu and Jean Truchon, who were suffering from serious health problems without being in agony.

"Now society is asking us to take into account people who are incapacitated or suffering from mental disorders," said CAQ MNA Nancy Guillemette, chair of the Special Commission on the evolution of the law concerning end-of-life care, on Friday.

She warned that the debate would be difficult and sensitive and that it could collide with MNAs' own values.

Quebec law has not changed with respect to the informed consent of the suffering person, which must be given up to the moment of receiving lethal treatment.

One of the new issues being discussed is whether or not to allow early application for authorization for people with Alzheimer's disease.

The commission includes Liberal MNA Marie Montpetit, Quebec Solidaire co-spokesperson Gabriel Nadeau-Dubois and Parti Quebecois MNA Veronique Hivon, who will hold seven days of consultations with experts, followed by public hearings in late summer.

It must table its report by November 19, 2021.

On Friday, the Expert Panel on Incapacity and Medical Assistance in Dying recommended that only people diagnosed with a serious and incurable disease should be able to apply early for assistance in dying.

He recommended that the person appoint a third party, who would act as a "proxy" and initiate treatment at the time deemed appropriate.

In response to a question from Hivon, co-chairs Jocelyn Maclure and Nicole Filion stated that in their view, it would be impossible for a person who had anticipated suffering, but who ultimately experienced happy dementia, to obtain MAID.

In their view, the advance application would be just that, an application, which would not be enforceable.

"A person who has dementia, but has a certain quality of life, do we really want to ask health professionals to come in and do MAID? Health care professionals have told us, 'We can't imagine doing that,'" said Maclure.

"The spirit of our recommendations is to wait until there is an irremediable and irreversible decline in ability and quality of life."

Dr. Mona Gupta, a clinical associate professor in the Department of Psychiatry and Addiction at the University of Montreal, recommended that a psychiatrist be involved in the assessment process for people with mental health problems.

In her opinion, a person who is experiencing an acute mental health crisis, or who would not have adequate access to care, should not be eligible to receive MAID.

It is difficult to list the mental illnesses that might be considered serious and incurable, she continued. Rather, one must consider the "totality of clinical circumstances."

She gave the example of a man who washes himself "20 hours a day until his hands are covered in blood," who no longer eats or sleeps, and who washes his toilet 400 times a day "because he perceives it to be contaminated."

"We're talking about a very small group of people," said Gupta. "[It's not] the neighbour who had a breakdown after his divorce... We're not talking about the 17-year-old who just had a breakup with his girlfriend."

END-OF-LIFE CARE COMMISSION OPENS OTHER DOORS

Since the law came into effect, 7,000 Quebecers have received MAID, which represents about three per cent of annual deaths, the Commission on End-of-Life Care reported Friday.

The commission, which was established by the National Assembly, has a mandate to examine any issue related to end-of-life care and to monitor the application of the MAID requirements.

Its chair, Dr. Michel A. Bureau, opened other doors on Friday, asking Guillemette's team to look into extending MAID to people with disabilities as well as to minors.

He acknowledged that with all these possible additions, Quebec is entering a turbulent zone, which is a necessary evil, he said.

"A 15-year-old with cancer who has an uncontrollable situation, why shouldn't he have access to MAID if his pain is unbearable?" he asked.

In the meantime, Bureau is urging the National Assembly to urgently change the law to waive final consent, as the federal government has done.

This report by The Canadian Press was first published in French on May 14, 2021.