Quebec end-of-life-care law means new era for health providers

Health-care providers in Quebec are figuring out what to do next following the adoption of Quebec's landmark end-of-life-care legislation.

The new legislation means that all health-care institutions have to acknowledge it by developing a policy and code of ethics on medical aid in dying.

Teresa Dellar, the West Island Palliative Care Residence’s co-founder and executive director, told CBC Daybreak host Mike Finnerty on Friday that the centre would not provide medical aid in dying to its patients.

“Certainly in palliative care, we will not be providing that service [...] Because we do not believe in hastening the natural process of death,” Dellar said.

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She said most terminally ill Quebecers in palliative care would surely choose to extend their lives if they could assure a certain quality of life and effective pain and symptom management.

However, Dellar said, the problem is that most Canadians do not have access to palliative care.

“Presently palliative care is only available to between 16 to 30 per cent of the Canadian population. I think when 100 per cent of Canadians have access to palliative care, then we can talk about other issues with end of life. But right now I think we need to focus on palliative care resources,” she said.

In late May, Canada's House of Commons passed a non-binding motion calling on the government to work with the provinces and territories to ensure access to "high-quality, home-based and hospice palliative care," provide more support to caregivers, and encourage Canadians to "discuss and plan for end-of-life care."

Ultimately, Dellar said, it’s the patient’s decision. “But it’s not something we’ll promote or provide.”

Doctor calls act 'euthanasia'

Dr. Paul Saba, who calls the act “euthanasia,” has been an outspoken opponent of the end-of-life-care legislation since the beginning.

In a news release, he said a motion was filed in Quebec Superior Court on May 27 to challenge articles in the act.

“First of all euthanasia is not a medical care. Quebec, a province of Canada, may only legislate in matters of health, not in criminal law. Euthanasia is a crime in Canada,” Saba’s release read.

The statement also makes reference to the lack of palliative care access in Quebec and the rest of Canada, pegging the number of Quebecers with access to it at around 20 per cent.

“How can a person make a free and informed consent? People have a right to have their suffering treated at the end of life and not their lives ended prematurely,” the statement continued.

Law passed 94-22 in free vote

The new law, "An Act respecting end-of-life care," was passed Thursday in a 94-22 free vote. All those who voted against the bill are members of the Quebec Liberal Party. (See photo below to see how your MNA voted.)

Work on the issue began several years ago, after a committee on dying with dignity was assembled under the Jean Charest government. The committee tabled its report in early 2012 and provided the foundation for the end-of-life-care act.

In the report, the committee wrote that it sought answers to some fundamental questions about illness and death:

"To die peacefully, surrounded by family and friends, or to simply slip away in one's sleep — such is the way many people would like their life to end. Unfortunately, the dying process can be agonizingly slow or involve a lengthy decline. In fact, over the past few decades, remarkable medical and pharmacological advances have increased life expectancy, sometimes at the expense of quality of life. What is our society's answer to the suffering experienced by some people at the end of life? How should we respond to requests for help to die? how do we ensure that people die with dignity?"

The legislation is unique in Canada, and rare in the world. Three American states have laws with provisions allowing for medical assistance in dying, and euthanasia is legal in the Netherlands, Belgium and Luxembourg. In Switzerland, a form of assisted suicide is legal.

"Sometimes when you are suffering in pain, one hour can feel like one week… The protection of the vulnerable is reflected in every aspect of this bill," said Parti Québécois member of the National Assembly Véronique Hivon, who drafted the bill when she was minister of social services under the former PQ government.

The act also underlines the qualifying conditions a person must be experiencing to be able to make a request for medical aid in dying:

• Be an insured person within the meaning of the Health Insurance Act.
• Be of full age and capable of giving consent to care.
• Be at the end of life.
• Suffer from a serious and incurable illness.
• Be in an advanced state or irreversible decline in capability.
• Experience constant and unbearable physical or psychological suffering which cannot be relieved in a manner the patient deems tolerable.

The whole act can be read here: