Dr. David Amies: In Quebec, inconsistencies reign in access to assisted dying

New reports coming out of Québec indicate show the legalization of assisted dying has not put the province on a slippery slope. However, ease of access varies greatly from region to region, which suggests the rules are being applied inconsistently. Dr. David Amies examines the reasons behind these inconsistencies in his latest blog post.

While we in the rest of Canada have been grappling with the consequences of the recently activated law on MAID, the Québécois have been quietly going ahead with the law that they introduced in December 2015

According to a recent report in Le Devoir, Québec recorded 166 assisted deaths in the period between December 10 and the beginning of July, a rate of about 250 per year. If you compare that to the number of total deaths the province registered in 2015 — approximately 65,000 — about 3.8 out of every 1,000 deaths occurring in Quebec involved medical assistance in dying. (In contrast, in the Netherlands and Belgium, countries where assisted dying has been legal for many years, assisted deaths represent about 34 deaths per 1,000 and 17 deaths per 1,000, respectively.)

Interestingly, while there have been 166 recorded assisted deaths in Québec so far, there have been approximately 250 requests made, meaning about one-third of requests have been refused

'Striking' inconsistencies between regions

The Le Devoir article holds that the machinery for dealing with requests for MAID is imperfect in some parts of the province and that there are striking differences in the various regions. It appears that there are several reasons for the overall high refusal rate. For one, there have been undue delays in obtaining the required second medical opinion. Some commentators suggest that doctors receiving a request for an opinion in these cases should use their best endeavours to provide it within 24 to 48 hours. Furthermore, there have been problems with evaluating the eligibility of individual patients. Some have been judged to be ineligible since Québec law only permits MAID for individuals whose death is likely to occur within six to 12 months of the request. Additionally, since advance consent is not allowed under the Quebec legislation, some individuals have lost their ability to make lucid demands before their eventual deaths from natural causes. Other individuals have decided to avail themselves of terminal sedation instead of going ahead with medical assistance to die.

The difference in the ease with which MAID is available across the province is striking. In the two major teaching hospitals in Montréal — McGill and the University of Montréal hospital — only 50 per cent of requests were actually carried out. It appears that the majority of patients likely to make such requests are in the beds of the palliative care unit and the doctors in charge have refused to participate. Others have taken a very restricted view of the law. The situation in Québec City and Sherbrooke hospitals, however, is quite different. In Québec City, 100 per cent of requests received were authorized, and in Sherbrooke, 80 per cent were authorized. Outside the university centres, access to assisted dying has been more consistent, and to date, all 19 received requests have been authorized.

Of course, these are early days. The new law has not yet been in place for a whole year. It will be interesting to see how things turn out as time passes and as the idea of asking medical advisors for help in bringing life to a premature end in the face of intolerable and incurable suffering becomes more firmly embedded in the public zeitgeist. So far, statistics show that there is no sign of the much dreaded “slippery slope”— dispelling arguments that have been posed by many viscerally opposed to the notion of medical aid in dying, both in Québec and elsewhere.

Dr. David Amies is a retired doctor in Lethbridge, Alta., and a member of DWD Canada's Physicians Advisory Council.

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