Quebec readies its doctors for legal assisted dying

The rest of Canada is watching with keen eye as Quebec prepares to become the first province to offer physician assisted dying to patients at end of life.

According to a recent article by National Post health reporter Sharon Kirkey, the Collège des médecins du Québec is providing doctors with the necessary tools to perform gentle and effective assisted death. The materials include a step-by-step list of instructions as well as a so-called "euthanasia kit" containing, among other things, a combination of drugs to sedate the patient and induce cardiac arrest. It will be made available by request to registered physicians only.

By the end of this year, physician assisted dying will be available to competent adult patients at end of life who are in an “advanced state of irreversible decline.” The new rules were adopted as part of a broader end-of-life care bill that Quebec legislators passed in June 2014 — almost a year and a half before the Supreme Court of Canada ruled to decriminalize physician assisted dying countrywide.

Made-in-Canada approach

The Collège, which regulates the practice of medicine in Quebec, partnered with the provincial college of pharmacists to review best practices from jurisdictions where assisted dying is legal. The Quebec team is recommending that doctors be allowed to administer treatment via I.V., an option that is available for patients in the Netherlands. The Quebec researchers decided against adopting the Oregon model, in which a doctor prescribes a life-ending medication that a patients takes orally at a time of his or her own choosing. The latter approach, said Dr. Yves Robert, the Collège’s director, isn’t always effective and sometimes leads to patients regurgitating the medication or waking up unexpectedly.

“In an oral route, it can take hours to have the effect,” Robert told the National Post. “We think there should be as minimum time as possible between when the act is begun and the effect occurs, to limit the effect on the patient, and on the family and friends.”

Leading the way

So far, Quebec is the only province to have passed legislation governing access to assisted dying. Ten of the other provinces, led by Ontario, have teamed up to study how they could develop a “harmonized” framework for assisted dying in response to the Supreme Court’s February ruling in Carter v. Canada.

The decision, which comes into effect on Feb. 6, 2016, struck down the Criminal Code ban on physician assisted dying and set out criteria for who will be eligible to end their lives with the help of a doctor. 

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