Papal visit could delay medically assisted dying for some Quebecers, health service warns

Some Quebecers may not be able to access medical aid in dying on their chosen date, due to highway closures planned for the papal visit next week.

All physicians in the Quebec City region who perform medical aid in dying (or MAID) at a patient's home receive their supplies from a pharmacy in Baie-Saint-Paul, a city about an hour outside of the provincial capital.

However, the route that runs to Baie-Saint-Paul, Highway 138, will be closed in both directions from 3 a.m. to 3 p.m. on July 28, when the Pope delivers his mass.

The health authority for the region, the CIUSSS de la Capitale-Nationale, said to expect delays — which could, in turn, set back some people's chosen date for MAID.

In a memo sent last week, the CIUSSS asked physicians to order their supplies in advance, or consider rescheduling the procedure to either before July 27 or after July 31.

Dr. Alain Naud, a physician in the region who administers end-of-life care, said it was inconceivable that patients could be asked to postpone.

"Often, the date is symbolic … it's already been announced to your loved ones, who are planning to be there. You can't move it like an appointment at a pharmacy or at an optometrist," he said.

"I think we have sunk into the height of absurdity and incompetence with this."

Doctors want changes in protocol

The delays are expected only to affect those planning to receive MAID at home. Hospitals in the region, including the CHU de Québec-Université Laval, prepare their own kits on-site.

As for why the at-home kits are only available in Baie-Saint-Paul, the pharmacy there is reportedly the only one with a sterile hood — something the Order of Pharmacists of Quebec has mandated is necessary to prepare propofol, the drug used in the procedure.

But Dr. Georges L'Espérance, a neurosurgeon and the president of the Quebec Association for the Right to Die in Dignity, said it "makes no sense" for the order to demand the use of the sterile hood.

"[We use the hood] so that there is no infection, so that there are no bacteria entering the product in question — but the patient will die within a minute. There is something absurd in that," he said.

Dr. Naud, who also administers MAID, agrees.

"We are forced to go and prepare medication — which is otherwise available everywhere in Quebec City, in all hospitals — in Baie-Saint-Paul, for an administrative directive that makes no sense and has no medical justification," he said.

When reached by Radio-Canada, the Order of Pharmacists of Quebec said it has no plan to change the directive.

No plans to cancel appointments

Naud said an agreement should have been reached before the visit, so the at-home kits could at least be prepared elsewhere, such as in the hospitals that already have and use the drug.

For its part, the health authority said it will do everything in its power to ensure that no MAID requests are cancelled due to the Pope's visit.

"All people who should be able to access medical assistance in dying before, during and after the Pope's visit will be able to do so," it said in a statement.

The CIUSSS said it has set aside a reserve of kits for use if needed, but is still asking doctors to delay the procedure if they can.

It also specified that the preparation of kits in Baie-Saint-Paul is "a proven and efficient process, which makes it possible to respond effectively to the needs of the population."