Montreal, Quebec, June 5, 2023 – On June 5, 2014, the Quebec National Assembly adopted Bill 52, “An Act respecting end-of-life care”. Back then, 22 MNAs opposed this opening to medical assistance in dying. Nine years later, Quebec Parliamentarians are preparing to vote on a number of new measures to expand access to medical assistance in dying. The Living with Dignity citizen network and many observers are under no illusions about the outcome. However, one big question remains: How many MNAs will stand up in the salon Bleu to oppose any of the proposed expansions? God forbid a unanimous vote on a subject with such high ethical stakes! We are pleased that the government has announced that its MNAs
will be granted a free vote, and we assume that all opposition parties will make the same choice. While the vote will probably take place very soon (no later than June 9, the end of the parliamentary session), here are four reasons to oppose the adoption of Bill 11, as amended by the Committee on Citizen Relations:
1 – Severe physical impairment: insufficient
safeguards to prevent abuses
As Mr. Pier-Luc Turcotte, a member of the Expert Panel on the concept of neuromotor disability who does not support the conclusions of the final report, brilliantly put it (in an open letter published in French on June 1st by Le Devoir and Noovo):
“The extension of medical assistance in dying to people with physical disabilities opens the door to major abuses, with very few solid safeguards to prevent them.”
We were pleased to co-sign this letter: “Se dépêcher à faire mourir avant de faire vivre” with Mr. Turcotte, an Occupational Therapist and Assistant Professor at the University of Ottawa’s Faculty of Health Sciences, along with 17 other groups and individuals. The content of the op-ed alone should make people hesitate to support Bill 11. It is also worth remembering the Fifth Estate (CBC) documentary which catalogued many cases of abuse in English Canada: The Mess that is MAiD. Bill 11 will not prevent such abuses.
We must promote medical assistance in living!
2 – Medical assistance in dying will be possible in cases of “happy dementia”, contrary to the consensus of the Special Commission and the Expert Panel
The comments of Dr. François Evoy, who was invited to testify before the Parliamentary Commission on April 20th by Minister Sonia Bélanger, the minister responsible for the legislation, makes us fearful of this expansion (see 1m30s video, in French). The criterion of contemporaneous suffering remains in Bill 11, but we understand that the legislator now seems to accept the idea that “happy dementia” can hide psychological suffering. Hence, a person who has signed an advance directive specifying that he or she wishes to receive MAiD even in the case of “happy dementia” could obtain it.
There is, however, strong opposition to this idea in many of the briefs presented at the consultations on Bill 11, both during the work of the Select Committee on the Evolution of the Act respecting end-of-life care (2021) and by the Expert Group on the Issue of Incapacity and Medical Aid in Dying (2019). Since Dr. Evoy’s remarks, the Committee on Citizen Relations has not added sufficient safeguards to discourage MAiD in cases of “happy dementia”. In addition, there is no acceptable framework for the clinical manifestations for receiving MAiD by advance directive. Many issues, including the sedation of individuals with diminished capacity prior to administering MAiD (which we discuss in our brief), have been postponed until the practical guide (to implementing the new legislation) is drafted.
3 – Profoundly unfair treatment of palliative care
hospices, particularly those not wishing to offer MAiD
From the outset, we denounced the idea of forcing palliative care hospices to offer medical assistance in dying. We were deeply disturbed when a new amendment proposed by Sonia Bélanger, Minister for Health and Seniors, made the Bill even tougher on palliative care hospices: “It (a hospice) cannot refuse to receive a person for the sole reason that the latter has submitted a request for medical assistance in dying”. This choice by the government is diametrically opposed to the wishes expressed by the Alliance des maisons de soins palliatifs du Québec during public consultations, and conflicts with their admission criteria. By adding on Wednesday evening a ridiculously short deadline (of 6 months!) for palliative care hospices not wishing to offer medical assistance in dying (of which there are only 4), Bill 11 unfairly targets those living environments whose mission is to offer quality palliative care to their community, respecting the palliative culture that has been freely chosen.
4 – Last-minute expansion – New MAiD locations: new
problems
News of the turnkey offer of MAiD by funeral homes made local headlines in Le Canada français (April 27th), in an interview on the ICI Première’s program (May 4th), but it was not until a publication in La Presse (May 19th) that a tide of incredulity followed. After expressing her discomfort, Minister Bélanger decided to make an accommodation for individuals wishing to receive MAiD in locations other than healthcare institutions, palliative care homes or their own homes. She proposed an amendment to prohibit the promotion and marketing of MAiD. Despite a sincere desire to avoid abuse, new problems can only be expected.
Three examples:
-Funeral complexes may be tempted to inflate the price of other services in order to offer free room rental for MAiD;
–Since there are conscience rights or right of refusal included in the law, owners of inns, campgrounds, or cottages, public park authorities or any other managers who express their disagreement with MAiD being offered in or on their property will have to bear the odious consequences of a possible refusal;
– As MP Joël Arseneau pointed out (in French) during the detailed study of the Bill, the availability of these new locations for MAiD risks making medical assistance in dying more attractive, all the while trivializing it even further.
If only this much effort and so many resources were deployed towards increasing access to palliative care – in the location of one’s choice, including at home – throughout Quebec!
Just one of these reasons is sufficient to oppose Bill 11.
Wishing all Quebec parliamentarians good judgment!
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