Quebec’s euthanasia law explained
Quebec’s historic Act Respecting End- of-Life Care came into effect Thursday, pending the Dec. 18 appeal of a Superior Court ruling that could effectively quash the law. In the meantime, it is legal for doctors to administer lethal injections to mentally competent, consenting adults who are at the end of life, have an incurable illness and experience “constant and unbearable” suffering. The Post’s Graeme Hamilton answers six key questions:
Is it euthanasia or assisted s ui c i de t hat Quebec has legalized?
Under the Quebec law, physicians will administer lethal injections to consenting patients. Quebec calls this “medical aid in dying,” but it is more commonly known as euthanasia. Assisted suicide, which is currently legal in three American states, occurs when a physician provides a patient with lethal medication that the patient uses to end his or her own life. Quebec considered but rejected the legalization of assisted suicide, concluding that it was preferable to have the physician administer the medication. Who is nasia?
To obtain medical aid in dying, patients must be 18 or older and capable of giving consent to care. They have to have a serious and incurable illness, be at the end of life in an advanced state of irreversible decline and experience “constant and unbearable physical or psychological suffering that cannot be relieved in a manner the patient deems tolerable.” The procedure must be re-
eligible
f or eutha- quested in a free and informed manner, using a governmentissue form signed in the presence of a health professional. In order to prevent euthanasia tourism, it is restricted to Quebec residents covered by medicare. Before administering euthanasia, the attending physician must obtain confirmation from a second physician that the conditions of the law have been met. How will physicians bring about death?
A guide prepared by Quebec’s College of Physicians spells out the three intravenous injections to be used in physician-assisted death. “It starts with anxiolysis (administration of an anti- anxiety drug), followed by induction of an artificial coma and, lastly, the administration of a neuromuscular blocker that causes respiratory arrest, cardiac arrest and death.” The procedure is expected to take 20 to 30 minutes. Doctors are advised to ensure the patient has a private room, to be punctual and to turn off pagers and cellphones. Family members can be present if the patient wishes. “Medical aid in dying should be marked by a profound solemnity that holds the protagonists’ undivided attention,” the guide says. Can a patient make a request to be euthanized in the event that they become incapacitated?
There is no provision in the law for a living will requesting euthanasia in the future. Patients have to be able to consent to care at the time of the procedure. “Despite the compassion engendered by each of these situations, the administration of medical aid in dying is prohibited if requested by a competent person who is experiencing constant and unbearable suffering but is not at the end of life, irrespective of whether he has a severe disability (tetraplegia, for example), or is in the early stages of a degenerative disease, or has a psychiatric illness, or wishes to die but his death is not foreseeable,” the guide for physicians says. Is a physician obliged to fulfil a patient’s request for euthanasia?
The law allows for conscientious objection by all health professionals, including doctors, nurses and pharmacists. Physicians whose moral or religious convictions prevent them from performing euthanasia must notify their hospital director, who will take steps to find a physician willing to accommodate the request. How might a federal law differ from what Quebec has done?
Ottawa has been spurred to action by last February’s Supreme Court of Canada ruling, which invalidated the Criminal Code prohibition of physicianassisted death. The high court gave the federal government and provinces one year to come up with new legislation, but Ottawa has requested a sixmonth extension and it has not indicated whether it will opt for euthanasia or assisted suicide. A spokesman for Prime Minister Justin Trudeau told CBC last week that Ottawa will “take inspiration” from Quebec’s lead. The Supreme Court ruling goes farther than Quebec’s law in one way. It says that to qualify for physician-assisted death, a patient must have a grievous, irremediable medical condition and experience intolerable suffering. But it does not require that a patient be at the end of life.