Confusion abounds over end-of-life practices

A third of Quebec doctors and nurses believe legalized euthanasia would give them the right to end the life of an incompetent patient at a relative’s request, according to a new survey that finds confusion over what is legal — and what is not — in end-oflife practices.

Overall, 35 per cent of respondents believed the use of lethal medication would be legal, when requested by a relative, under an assisted dying scheme — despite the fact every Quebec government report since 2012 has made clear a voluntary request would have to come from the patient.

“There are various interpretations of what would or would not be allowed if medical aid in dying were legalized,” the authors write in the journal Canadian Family Physician. The findings, they said, have national implications as the country prepares for the legalization of doctor-assisted death next year.

Respondents seemed equally confused about what is already legal in Quebec. More than 20 years after the famous case of Nancy B., a 25-year-old quadriplegic from Quebec City who was allowed to be disconnected from life support, nearly half of those surveyed said patients do not have the legal right to ask that life-prolonging treatments be withdrawn.

The sample size was small — 271 family doctors, specialists and nurses who responded to a questionnaire involving six scenarios. But it’s being described as the first attempt in Canada to measure health care professionals’ understanding of the legal status of end-of-life practices.

The survey shows many have trouble distinguishing one practice from another, or what, exactly, constitutes euthanasia.

According to the authors, more than half — 56 per cent — of respondents had experience with end-of-life care.

“The culture here is to prolong life at any cost the great majority of time,” said Manuel Borod, director of supportive and palliative care at McGill University Health Centre in Montreal, “and I think patients are afraid of that.”

While there is confusion around terminology, “the bill in Quebec is clear that people have to be competent” to request a doctor’s assistance helping them die, Borod said. Once enacted, Bill 52 will permit Quebec doctors to administer a lethal injection to patients of legal age who are mentally competent and suffering an incurable illness with “constant and unbearable” physical or psychological pain.

The Quebec survey was conducted between September 2012 and January 2013, a year before Bill 52 was passed into law.