Quebec health minister introduces bill to expand access to medical assistance in dying

Health Minister Christian Dubé tabled a bill Wednesday that would allow people with Alzheimer's, for example, to make an early request for medical assistance in dying (MAID). 

The long-awaited Bill 38 takes up most of the recommendations made last December by the special all-party commission on the evolution of the Act Respecting End-of-Life Care.

But it contains a provision that was not included in the commission's work: the extension of MAID to people with severe neuromotor impairment, such as quadriplegia.

"With neuromotor disorders, there is also the question of suffering," said Dubé in a press briefing, saying that he wanted to harmonize the Quebec legislation with that of the federal government.

Paraplegia, cerebral palsy, and amputation after an accident are also serious neuromotor disabilities.

'PULLING A RABBIT OUT OF HIS HAT'

But this last-minute addition has "complicated enormously" the adoption of the bill, Parti Quebécois (PQ) MNA Véronique Hivon warned Wednesday.

She believes that the minister is opening up "a whole other area" that has never been debated in Quebec, and that it will be difficult to debate it properly with only nine days left in the legislature.

"This is not a trivial choice for the minister, and I must tell you that I wonder, really, why he came up with this."

Minister Dubé should have stuck to the recommendations of the transparent commission, according to Vincent Marissal, MNA for Québec solidaire.

"He's pulling a rabbit out of his hat by adding neuromotor disability as a reason to apply for [MAID], when this condition was barely touched upon during the consultations," he said.

If adopted, Bill 38 will allow a person suffering from a serious and incurable disease leading to incapacity (dementia, Alzheimer's, Parkinson's in certain cases) to choose his or her end of life.

They will be able to decide, with the help of a physician or specialized nurse practitioner, at what stage of the disease they wish to end their life, even if they are no longer capable of giving consent.

The request would be recorded on a form completed and signed in the presence of the health-care professional, and countersigned by two witnesses or notarized. It would then be recorded in a registry.

The person will be able to designate one or two trusted third parties whose role is to inform a physician or specialized nurse practitioner when they believe the person is experiencing the suffering described in the request.

A person who is alone and does not have a trusted third party will be accompanied by health-care staff, though a person may modify or withdraw his or her advance application for MAID.

Approximately 140,000 Quebecers currently suffer from Alzheimer's disease.

On the other hand, Minister Dubé sided with the Transpartisan Commission and refrained from extending the MAID to people with a mental disorder only.

"Will we go back to this later, when there may be another update? But right now, it really wasn't the right thing to do," he said.

Another change proposed in the bill is that a hospice will no longer be able to exclude MAID from the care it provides, with some exceptions. Currently, six of the 37 hospices in Quebec do not offer medical assistance in dying.

Finally, the bill removes the "end of life" criterion from the eligibility requirements for the procedure, since it is already no longer applicable.

END-OF-SESSION GRIDLOCK

In order to be able to study Bill 38, Dubé said he was ready to pass Bill 19 (health information) to the hatch.

In a press conference, he defended himself from being poorly organized, as he is currently piloting four health bills. However, he acknowledged that the agenda was "very tight."

"We have a group of lawmakers who, until a few weeks ago, were still working on COVID and then on a lot of things ... The minute we got (Bill 38) from our people, we tabled it," he said. 

Under the rules of the National Assembly, a bill introduced after May 15 "cannot be passed during the period of proceedings in which it was introduced."

This rule can be circumvented, however, if the government obtains the agreement of all elected officials.

-- This report by The Canadian Press was first published in French on May 25, 2022. 

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