Feature: Bill C-14 reignites assisted-dying debate in Québec

Doctors, patients and lawmakers in Québec are expressing mixed reactions to Canada’s new assisted-dying law, which comes just months after the province enacted its own legislation on end-of-life care.

Québec is the only province with assisted-dying legislation – Bill 52 –already in place. In July, it was reported that 166 patients in Québec have requested and received the procedure since the law came into effect in Dec. 2015.

“The adoption of the Québec law is positive in the sense that it allows people at the end of life the choice not to prolong their state of suffering unnecessarily,” says Gail Ouellette, president of Alliance des patients pour la santé and of Regroupement québécois des maladies orphelines.

She says while the law is a good start, some patients are still travelling to other countries to receive medical assistance in dying or are ending their own lives in Québec because they do not qualify for assistance.

“We must face this reality and listen to these people,” says Ouellette. “Maybe this will lead to a wider assisted-dying law which will enable such people to know they have a choice too.”

She says it is important to note that patients, particularly people with disabilities, have diverse opinions on assisted dying.

“They fear that the desire of a minority of people with disabilities to be free of their suffering is interpreted in the general population as if life with disabilities is not worth living and that death is preferable,” Ouellette explains. “While respecting the desire of this minority, they also want to fight against prejudices still present in our society.”

The federal law, Bill C-14, also stipulates that patients must be at the end of life to receive medical assistance in dying. The British Columbia Civil Liberties Association and 25-year-old Julia Lamb, a B.C. woman with spinal muscular atrophy, are arguing that Bill C-14 is unconstitutional because of this restriction.

In 2015, the Supreme Court of Canada stated that laws criminalizing doctor-assisted death violate the rights of adults with “grievous and irremediable” medical conditions.

“The Supreme Court decision was not premised on any kind of requirement that people who have a right to a medically assisted death have to be otherwise near death,” explains Cara Faith Zwibel, director of the Fundamental Freedoms Program at the Canadian Civil Liberties Association.

“They want it to be kind of a free-for-all for whoever wants it, for whatever reason, based on the idea of suffering,” argues Dr. Paul Saba about court challenges against current restrictions for doctor-assisted dying.

Dr. Saba, a physician based in Lachine, QC, and president of the Coalition of Physicians for Social Justice, says attempts to remove the end-of-life requirement and other limitations can create situations in which minors, people who are misdiagnosed, or those who cannot afford medical treatments die prematurely.

“Our goal is to provide people with the best possible care according to scientific principles,” he explains. “The best scientific principle says if you can treat, treat, and if you can’t treat, you relieve the pain. You don’t kill the patient.”

While doctors are not obliged under either law to fulfill a patient’s request for medically assisted death, they must effectively refer the patient to a doctor who does not object.

“I think we probably should not force medical professionals to do anything they’re not comfortable doing,” says Zwibel. “Where the thing they’re not comfortable doing is referring [a patient] to someone else, I think that may be a burden that they have to bear.”

Québec’s College of Physicians and the Québec bar association have called for a harmonization of the federal law and provincial laws.

“I think Québec has a very courageous and very advanced law,” says Jocelin Lecomte, a Montréal-based health lawyer and member of the association’s committee on human rights. He says he agrees with the association’s assessment that Québec’s law offers more protection to physicians.

“Let’s not forget that the Québec law was written in another political sphere,” Lecomte says. He notes that under the administration of former prime minister Stephen Harper, there was “a serious preoccupation” among doctors that they could face criminal charges for assisting a patient in dying.

Lecomte says the legal architect of Bill 52, lawyer Jean-Pierre Ménard, created it under the umbrella of health care to protect both doctors and patients.

“[The bar association], and I think society as a whole, did not want people to just be able to go to a pharmacy, have their prescription, bring it home, and then decide when they’re going to put an end to their days.” Under Bill C-14, patients can self-administer death using drugs prescribed for this purpose by a doctor.

Lecomte says he looks forward to having more data on how Bill 52 is being implemented, including numbers on how many doctors are referring patients to other physicians or other institutions, to assess whether it can be improved.

“It’s very subjective, so we’re seeing that a lot of doctors, even though there are guidelines, they’re acting according to their values and their perceptions,” he says. “If you’re living in Abitibi-Témiscamingue or Gaspésie, you have the same rights, so you should be able to have access to the same services.”

Questions of access were raised after it was reported that the McGill University Health Centre had not updated a policy that required patients in palliative care to be transferred to a different unit for assisted death. Parti Québécois MNA Véronique Hivon, who drafted Bill 52 and remains one if its most vocal defendants, accused Québec Health Minister Gaétan Barrette of obstructing the law after he directed doctors to wait 10 days after a request for assisted death is made before administering the procedure – a guideline taken from Bill C-14.

“Why is the government putting so much energy into ending people’s lives rather than providing the best possible care?” asks Dr. Saba. “Is it because it’s a faster, easier, less expensive solution?”

Dr. Saba presented his arguments during consultations on Bill 52 and provided a brief to the Canadian Parliament against Bill C-14. He continues to challenge both laws in court.
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