Memo reminding Quebec doctors to respect new MAID law is intimidating, advocates say

Quebec's commission on end-of-life care is reminding the province's doctors to closely follow a new law affecting medical aid in dying (MAID), but one association says the warning is unwarranted and might dissuade doctors from providing the procedure altogether. 

The head of the commission says he sent out a memo this week to try and clear up any confusion about expanded availability of MAID — which came into effect in June — and advise doctors of the proper application of the law. 

"Each time there is modification in the law, there is certain confusion among the physicians providing MAID. They question, 'Is it within the boundaries of the law, is it permitted or not?'" said Dr. Michel Bureau, president of Quebec's commission on end-of-life care. 

The new law allows people with serious and incurable diseases to apply for MAID before their condition deteriorates.

The commission reviews about 500 requests for doctor-assisted death every month, but Bureau says two to three of those monthly applications don't meet provincial guidelines. He says doctors must recognize those cases. 

"At times, [physicians] don't know really if they are right or not and at times, they're not," he said. 

The memo reminds doctors of several guidelines, including that requests due to old age do not meet provincial criteria for the procedure, and an independent opinion from a second doctor isn't a formality — it's a requirement.

Bureau said any deviation from the rules can be a slippery slope, especially as the commission is seeing an increasing number of requests for MAID.

However, Georges L'Espérance, a neurosurgeon and the president of the Quebec Association for the Right to Die in Dignity, says the numbers are going up because of the increased understanding that MAID is an option.  

He criticizes the memo, saying it might stigmatize the procedure or even dissuade some doctors from providing it. 

"The problem is that many doctors will be intimidated by that kind of memo," he said. "They will say that they don't want to [administer] any MAID because they have fear." 

Bureau disputes this, saying that the memo is just about reminding doctors of the rules so that ineligible applications don't fall through the cracks. 

The commission expects MAID to account for seven per cent of deaths in Quebec this year, compared to a previous high of five per cent.