Quebec urged not to rush expansion of medically assisted death to mental health patients

The Quebec government has promised to hold "at least one day" of public consultations about its intention to allow people with mental illness to seek a medically assisted death.

Health Minister Danielle McCann was facing outcry after announcing earlier this week that the government would comply with a Superior Court decision that struck down the "end-of-life" requirement in Quebec's law on medically assisted death.

McCann's announcement meant that as of March 11, medically assisted death would be accessible to people with mental illnesses, as well as others with incurable but not terminal symptoms.

That sparked concern the government was pushing ahead with a major change without thinking through the consequences.

McCann responded to the pressure on Thursday, saying a public consultation will take place next month. It may include an online component.

The minister also sought to reassure those who feared the new policy will make it too easy for people with mental illnesses such as depression to receive a medically assisted death.

"We're talking about exceptional cases," McCann said Thursday in an interview with Radio-Canada. 

"We're talking about people with extremely severe, persistent disorders, decades of inefficient treatments — people who are resistant [to treatment]. It's a very small number of people who would be able to receive medical aid in dying in this context."

McCann has asked the Quebec College of Physicians to draft guidelines for determining when a patient with mental illness can qualify for the procedure.

These requests will take time in order to be properly evaluated, said Dr. Yves Robert, a representative of the college.

"Several mental disorders involve a wish to die as a symptom," he said. The challenge for doctors will be distinguishing between a wish to die that is a symptom, and one that is "free and informed." 

Robert said it was important to remember that not all requests for a medically assisted death are granted. "It's a constitutional right to make the request. But it's a conditional right to obtain it."

Quebec entering 'grey zones:' expert

But even with McCann's promise to hold public consultations, opposition parties remained worried the government was pressing ahead too quickly.

"It's clear more time is needed," said Véronique Hivon, the Parti Québécois's critic for end-of-life care, who also played a key role drafting Quebec's assisted dying law.

Hivon said the government should have asked the court for an extension.

"You can't just be in a legal bubble and say there's a judgment and it's going to land like that, like magic, without preparing things," she said.

Hivon's concerns were echoed by a leading expert on the issue. Éric Racine, who heads a health ethics research unit affiliated with the Université de Montréal, said the Superior Court ruling threw Quebec into uncharted territory. 

"We're in grey zones here and we're at the very beginning of what should be a debate, but is going fast, fast, fast at the legislative level," said Racine.

"The need for dialogue may be even more crucial, but we haven't really been able to prepare for this."

Racine said the Superior Court decision, which removed the end-of-life requirement, is prompting Quebec to think hard about the ethics of well-being.

Without that requirement, more weight will be placed on the evaluations done by the health professionals considering the application for an assisted death. In mental health cases, these are more subjective, Racine said. 

"As you can easily understand this is not easy.... These are assessments that need to be thoughtful," he said.

"It raises questions about how we view suffering and the well-being of the person."