An update from Quebec

While the federal government says it isn’t planning to table new assisted dying legislation before this year’s federal election, Quebec’s work to implement new laws surrounding end-of-life choice is well underway.

The province passed Bill 52, An act respecting end-of-life care, in June 2014, with the law set to come into effect by the end of this year. The new rules establish palliative care as a right for all Quebeckers. In addition, physician assisted dying will be available for terminally individuals in hospitals, nursing homes and hospices, as well as patients who wish to die at home.

DWD Canada CEO Wanda Morris recently spoke with Dr. Daniel Weinstock, the Canadian Research Chair on Ethics and Political Philosophy at McGill University, about how Quebec’s preparations are progressing. Though not a verbatim transcript, the following Q&A is collection of key points of their conversation. It offers helpful updates what the regulations and safeguards the Quebec law with the guidelines set out by the Supreme Court in its historic ruling in Carter v. Canada.

Q. Will Quebec still be proceeding with the December 31, 2015 timeline for implementing Bill 52, An act respecting end of life care?

A. Yes. While the health ministry in Quebec has recently been focused on a major healthcare reorganization, all indications are that Bill 52 will come into effect by the end of the year as envisaged in the current legislation.

Q. This means that physician assisted death will be legal in Quebec before the decriminalization ordered by the Supreme Court of Canada comes into effect on February 6, 2015. Do you anticipate an issue with the federal government over this timing?

A. No. While we will precede the rest of the country by a few months in implementation, it is highly unlikely that the federal government would sue Quebec one month and then shortly thereafter turn to Quebec legislation as a possible model for cross-Canada implementation.

Q. The Supreme Court of Canada decision in Carter (for the right to die with dignity) allows for broader eligibility for assisted dying than Quebec’s Bill 52. (Unlike Bill 52, the Supreme Court did not limit access to assistance to die to those who are at end of life). Does the Quebec government plan to address this discrepancy?

A. Quebec MLA Véronique Hivon had noted this discrepancy and indicated that the government would need to re-legislate. Now that we have a different party in government it is not clear whether the existing legislation will be amended or whether it will take a court challenge to bring the legislation into line with the decision of Canada’s Supreme Court.

Q. We have heard from Quebec and indeed across Canada that some institutions would prefer to prevent willing doctors from provide physician assisted dying to eligible patients who request it. Will they be allowed to opt out?

A. There is a very narrow opt-out option for stand-alone hospices, of which there are few in Quebec. Other than these stand-alone hospices all institutions that provide end-of-life care (such as hospitals, long-term-care and residential care facilities) must honour the rights of patients to seek such treatment and the rights of doctors to follow their consciences in providing it.

Q. What is required of a doctor who does not want to provide assisted dying to a patient?

A. Quebec has recognized the right of conscientious objection for physicians who do not wish to provide assistance to die to their patients. Quebec also recognized patients right to access physician assisted dying and not be abandoned. Quebec has reconciled these potentially opposing rights by requiring doctors who will not provide assisted dying to refer patients who request assistance to an individual within their institution who will access a willing provider for the qualifying patient who can then exercise their right to a peaceful, assisted death.

Q. What happens to life insurance for individuals who chose an assisted death? (Ed note: Most life insurance policies have a two-year exclusionary period; life insurance is not valid if a death by suicide occurs during that time frame. In order to protect those who opt to use physician assisted dying, legislation in jurisdictions where physician assisted dying is practiced — for example, in Oregon, Washington and the Netherlands — requires that life insurance be paid out as if the patient died a natural death.)

A. I’m not aware that this issue has been addressed. It is something that the Quebec government will have to look into.

Q. Is Quebec going ahead with oversight and reporting of assisted dying?

A. Yes indeed. It is in the law so they will have to do this. It may be that this task is left to the institutions rather than being done centrally,

Q. One of the questions being asked by many of our members is whether there are provisions in Quebec for those with a dementia diagnosis to have assistance to die.

A. Quebec’s current legislation restricts assistance to die to someone who is competent at the time of requested assistance to die, and at end of life. The requirement to meet both these eligibility criteria excludes people from having assistance to die when they have a dementia diagnosis. When individuals are first diagnosed and in the early stages of dementia, they are likely still competent but they would not meet for the criteria for being at end of life. When individuals are at end of life, they are unlikely to be competent due to the impact of their dementia.

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