Quebec, Canada, and the Right to Die

This week: The question of whether a doctor can assist patients who want help in dying is moving from the back burner to the front -- and no where is that more apparent than in Quebec.

In February, the Supreme Court of Canada ruled that the Criminal Code provision against aiding and abetting someone to commit suicide deprives terminally ill patients of their rights under the Charter of Rights and Freedoms. 
    
The government was given until Feb. 6, 2016 to amend the law, but on Thursday the new  Liberal government asked the court for a six-month extension.

But Quebec doesn't want to wait. It already passed Bill 52 - an act Respecting End of Life Care. It gives terminally ill people the right to receive treatment for severe pain, sedation at the end of life, and limited access to medical aid in dying from a doctor. 

But that bill has hit a major snag. This week, a Quebec court put the legislation on hold until the Criminal Code can be amended.  Now, the province is asking the Supreme Court to rule on the issue - and fast. They still want to bring in their legislation as planned on Dec. 10, arguing that the issue is related to health care - something the province has jursidictin over. 

As the legal wrangling continues, doctors in the province are on standby, after months of preparing for what's been called a "seismic shift" in medicine. 

The Quebec College of Physicians, along with nurses and pharmacists, have written precise guidelines on how to end the lives of consenting patients - including kits that contain the right combination of lethal drugs -- ones that doctors themselves will have to administer. Hundreds of Quebec doctors have taken courses on using them. 

But many of the province's palliative care doctors want no part of it -- saying their job is to help relieve the suffering of patients as they die, not to take part in killing them. 

Dr. Vanessa Cardy pracitices palliative care in Chisasibi, on the shores of James Bay in northern Quebec. She has broken ranks with her colleagues, telling Dr. Brian Goldman that she is willing to aid patients who meet the criteria to receive medical aid in dying under Bill 52.  But she says it's not something she would ever "do lightly."

"I really convinced myself this was the right thing to do in these certain cases, because we can't palliate everything. I wish we had a pill or an injection that could take away some of the horrible things people have to go through at the end of their lives,' Dr. Cardy says. 

Part of what convinced her was seeing patients who felt they had to take extreme measures when no other option was available. 

There have been many instances where I've seen suffering where I think it's unbearable...Now we will have an option.- Dr. Vanessa Cardy 

 "I've had palliative patients who have attempted suicide, who succeeded sometimes, and others who haven't succeeded and have ended up in an even worse-off state than before," she says. 

Cardy says one of her patients has already spoken to her in general terms about getting help to end her life once Bill 52 comes into effect. 

"I did say, once it's legal,  if you're still feeling that way we have to talk again."

She says she's now "stressed" for her patient, who, because, of the delay, will not have the option of asking her for help in dying. 

"If I had to make a bet on it, which sounds crass, but its not meant to be, I would think that yes, this patient would not be able to access medical aid in dying."  

Meanwhile, doctors in other parts of the province are also preparing for requests from patients who want help in dying. 

We spoke to a panel of three doctors who are at the forefront of implementing Bill 52. 

Dr. Yves Robert is secretary of the Collège des médecins du Québec. He says that the college has worked long and hard to comply with the bill, which says that patients may only receive treatment to end their life when death is "imminent." 

When asked what that means, he conceded that it's still difficult to define under the law. 

"As physicians, as a college we understand it's a matter of days, of weeks, surely not years, maybe some months." Robert says.

Dr. Eugene Bereza  is Director of the Centre for Applied Ethics at the McGill University Health Centre (MUHC), and Associate Professor and Director of the Medical Ethics Program in the Department of Family Medicine.

He is part of a committee developing MUHC's response to Bill 52 - which compels institutions to offer medical aid in dying even while allowing individual physicians to conscientiously object.

While Dr. Bereza takes no position on the bill, he says the measures in it are quite different from the way physician-assisted death is carried out in other places -- something  he says the public may not fully understand yet. 

"This is a different ball game...It's the physician who actually has the syringe in their hands, pushes that syringe and administers that medication, knowing that the ultimate goal will be death." Dr. Bereza says. 

Dr. Manuel Borod  is the Director of the Division of Supportive and Palliative Care Programs at MUHC and Assistant Professor of Oncology at McGill University.He says he doesn't know of any palliative care doctors at his hospital who would assist a patient in dying - himself included. 

"Remember that we are not the most popular physicians to go and see. If you're at a cocktail party and I tell you what I do, you do not want my card...When you continue to link aid in dying to palliative care. patients who are facing end of life situations will be reluctant to be seen by palliative care, because there's this association with hastening death."

If we were offering hastened death, (patients) would be afraid to close their eyes at night, feeling that the angel of death is coming with a syringe during the night.- Dr. Manny Borod 

 Dr. Borod says he does not want patients requesting aid in dying to recieve their final treatments on the palliative care ward. 

You can listen to a longer version of our panel below.