Will Quebec set the standard for physician-assisted death?

FILE - In this Sept. 5, 2013 file photo, chemotherapy is administered to a cancer patient via intravenous drip in Durham, N.C. (AP Photo/Gerry Broome, File).
FILE - In this Sept. 5, 2013 file photo, chemotherapy is administered to a cancer patient via intravenous drip in Durham, N.C. (AP Photo/Gerry Broome, File). Gerry Broome, AP File

With a little over four months to go before physician-assisted death is no longer illegal in Canada, various jurisdictions are scrambling to come up with laws that will determine who can ask for help in dying, how cases should be evaluated, and how doctors can actually end a person’s life.

The justices of the Supreme Court ruled in February that it should no longer be a crime for a doctor to help certain patients die, giving Ottawa and the provinces exactly one year to figure out how to fill the legislative vacuum that their decision would create. But lengthy delays, followed by the longest federal election campaign in recent memory, have meant that drafting and passing legislation before February 2016 will now prove difficult, if not impossible.

Federal and provincial-territorial expert panels recently began looking at how jurisdictions might regulate physician-assisted death, but they’re nowhere near finished their work. According to Robert Leckey, director of the Paul-André Crépeau Centre for Private and Comparative Law at McGill University, it’s unclear if the country’s top court might extend the deadline.

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“In a Charter case we don’t normally see the government coming back and seeking an extension,” Leckey said, adding that “the fact that Ottawa gave the appearance of doing nothing until July” may make it harder to convince the judges.

But in one province, nobody is scrambling at all. Quebec moved ahead with assisted-dying legislation in 2014 in spite of opposition from Ottawa, and is now preparing to usher in an era of legal and carefully monitored physician-assisted death, starting in December. Any doctor who agrees to end a patient’s life in Quebec will be able to do so, as long as they follow the letter of the provincial law and a specific set of guidelines issued earlier this month by the professional order of Quebec physicians.

The Collège des médecins du Québec said it would publish the guidelines, which contain instructions for administering a series of drugs to cause death, in both French and English on a secure section of its website not accessible to the public.

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Asked if everyone else could look to Quebec for guidance, Dr. Cindy Forbes, President of the Canadian Medical Association, said her organization “will be watching very closely what happens there, and lessons learned.”

The CMA’s biggest concern, Forbes said, is still that Canada will end up with a patchwork of different laws and guidelines come February.

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“It would be in everyone’s best interest to have a national approach so that procedures, legislation and rules are the same no matter what province you live in.”

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Changes to the Criminal Code would be made federally, but any changes to regulation for physicians and any legislation related to delivery of healthcare would likely need to be implemented by the provinces, which have jurisdiction over those matters. All of this takes time, Leckey pointed out.

“Twelve months, in a way, is too short for a legislative process of this magnitude, but it’s also too long if you’re suffering.”

Quebec’s current law may also need to be tweaked, given that it would likely fail a court challenge because it restricts physician-assisted dying to people at the end of their lives. The Supreme Court’s decision does not. Still, said Forbes, the province’s approach contains much of what the CMA is calling for, including an oversight body to monitor physician-assisted death, the ability for the patient to withdraw their request to die at any point, and a requirement for a second opinion before a doctor can end a patient’s life.

Even if Quebec’s assisted-dying legislation and the guidelines from the Collège des médecins aren’t copied exactly across the country, Leckey said, the province’s approach to drafting and passing its law should be.

“Quebec bent over backward to make this a consensual process. They did a really careful job not to make it partisan. There were a lot of steps … there was a lot of space for people to express themselves.”

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Quebec’s approach

Only patients covered by Quebec’s provincial health plan are able to ask for help to die, a clause designed to prevent people from flocking to the province from elsewhere.

Only terminally ill patients in a very specific set of circumstances can seek a doctor’s help to end their lives. They must be suffering from a serious and incurable illness, be in the later stages of that illness, and must be experiencing constant and intolerable physical or psychological suffering.

 The patient must be sound of mind and be capable of making the decision to personally request that a doctor help end their life. The patient must sign and date the formal request themselves using a form provided by the health ministry.

The doctor must assess — over a period of time — whether the patient meets the various criteria to qualify for doctor-assisted death, make sure they are informed of all their options and then seek the opinion of a second doctor who has no previous connection to the patient. Both doctors must physically examine the patient.

The doctor may only end a patient’s life with sequential injections of three medications: a sedative such as a benzodiazepine to relieve anxiety, a barbiturate or similar drug to induce a coma, and finally a neuromuscular block, which stops the heart and respiration. Detailed instructions will tell the doctor how and where to inject the drugs, the quantities needed and what to do in the event of complications.

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Euthanasia kits will be prepared by pharmacists based on the physician’s prescription. Each kit will contain enough drugs and injection equipment for two euthanasia procedures, in the event a backup set is needed. Doctors must return any unused medication to the pharmacy.

The patient may bring an end to the procedure at any point, even in the later stages of the administration of the medications.

With files from the Canadian Press

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