Canada: Debates on Expanding Medical Assistance in Dying

In Quebec, a bill to expand medical assistance in dying, in force since 2015, is currently being consulted by the National Assembly. But the text provokes a societal debate on the notion of disability in particular. Getty Images/iStockphoto - doble-d

Text by: Alexis Gacon

3 min

In Quebec, a bill to expand medical assistance in dying, in force since 2015, is currently being consulted by the National Assembly. But the text provokes a societal debate on the notion of disability in particular.

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In Canada, medical assistance in dying is becoming increasingly popular. Two years ago, the total share of deaths related to this aid was just over 3%. Now, it exceeds 7%, which places the province of Quebec at the top of the ranking, ahead of Belgium or the Netherlands.

These figures have caused the Commission des soins de fin de vie to tick, which has launched consultations to understand the popularity of this recourse. And according to the president of the commission, the law is more and more accepted in society, but it is still well framed, well marked. The law remains, according to the commission, used only as a last resort.

Expanding access

If the plan to expand access to medical assistance in dying were adopted, the new version would give access to people who suffer from a severe and incurable neuromotor disability, such as paraplegia or cerebral palsy. The new bill also provides that a person suffering from a serious and untreatable illness that leads to incapacity, such as Alzheimer's disease, has the opportunity to make an advance request for assistance when he or she is still able to consent to care. That is to say, a patient who knows that the disease will make him incapable of consenting to care, makes the request when he is still conscious to trigger it later.

► Read also: A brief history of euthanasia and assisted suicide since Antiquity

At this time, to access medical assistance in dying, you must check all of the following boxes: being able to consent to care, suffering from a serious and incurable illness, experiencing constant and unbearable suffering, and being in an advanced and irreversible phase of decline. It is this last aspect that would be transformed by the bill.

Opening too restrictive

But the debate is still raging. The college of physicians, which represents the professional order, speaks well of the text, but finds that opening only assistance to people with motor disabilities is too restrictive. For the college, this word should be removed and help should be made accessible to all serious and untreatable disabilities. Véronique Hivon, the former MP behind the first aid law in 2015, disagrees. For her, if we remove this word, "it will open up help to people who have a severe intellectual disability". She wanted a broader debate.

And the other part of the bill that is much discussed is the issue of advance requests. The president of the end-of-life care commission, Michel Bureau, said that this component was going to be difficult to supervise. A person who is at a very early stage of Alzheimer's can ask for help when they are able, but then, when you get to the stage where help is started, the doctor who follows them may not be the same as at the beginning and may be reluctant if the person shows signs that they are now opposing help or if they seem happy. even very affected by the disease.

And precisely, on Radio-Canada, the Quebec Federation of Alzheimer Societies stated that those who live "happy dementia" should not have access to medical assistance in dying.

► Also listen: Switzerland: the quiet death

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• Canada
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