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• Medical aid in dying in Quebec and Canada: facts matter
  Michele Marchand
  Published on: 5 January 2017

• Published on: 5 January 2017

  Medical aid in dying in Quebec and Canada: facts matter

  • Michele Marchand

  As an active participant in the debate that took place in the province of Quebec concerning medical aid in dying (MAID), I would like to take the liberty of commenting on an article by Udo Shuklenk published recently in your journal: "Canada on course to introduce permissive assisted dying regime". In my view, some of the factual information given in this text needs more precision.

  First of all, the chronology...

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  As an active participant in the debate that took place in the province of Quebec concerning medical aid in dying (MAID), I would like to take the liberty of commenting on an article by Udo Shuklenk published recently in your journal: "Canada on course to introduce permissive assisted dying regime". In my view, some of the factual information given in this text needs more precision.

  First of all, the chronology. In fact, the debate began in Quebec long before and on other bases than in the rest of Canada (ROC). When Gloria Taylor and Kay Carter's family decided to contest the Criminal Code prohibition in British Columbia (BC) in 2009 and 2010, the public debate was already going on in Quebec, where the drive to change was not a court action but a political decision. On December 4, 2009, the National Assembly created a special commission to discuss the issue of end-of-life care in public. When the BC Supreme Court rendered its decision in favour of the plaintiffs in June 2012, this commission had already completed its report, which was submitted on March 22, 2012. And when the Supreme Court of Canada (SC) released its decision in Carter in February 2015, Quebec had already adopted its Act Respecting End-of-Life Care. Adopted on June 5, 2014, the Act has been in force since December 2015. As to the report of the Royal Society of Canada's expert panel, of which the author was a member, it was submitted in November 2011.

  So, this "high-profile report of an international expert panel", as the author puts it, may have had a great influence on the SC decision. And it is evident enough that the SC decision itself had a great influence in the debate. But it is a little difficult to follow the author when he concludes: "The other lesson, from Canada at least, is that what was required to drive the change that is now coming was court action." And it becomes almost impossible to follow him when he says, concerning the debate in Quebec: "At the last minute opponents of assisted dying succeeded in raising the access threshold from being a competent adult suffering an irreversibly low quality of life which that adult does not consider worth living by adding a further access criterion: the person must also be towards the end of their lives." I really don't know where this information can have come from. In fact, for many reasons that it would be interesting to discuss more seriously because they are not only contextual, the debate in Quebec was, from start to finish, limited to end-of-life care. This has nothing to do with the opponents' arguments, who were against any opening at all, all along.

  I think it is important to be extremely clear about the facts because it might change the perspective on controversial issues such as access criteria or conscientious objection.

  With respect to access criteria or scope, the author does not seem capable of even imagining that providing limited access to people near their natural death can be a defensible position. He explains that two committees addressed the issue in their reports since the election of a new parliament in Ottawa at the end of 2015: a provincial-federal expert panel and a parliamentary-senate special joint committee. "These two documents combined arguably constitute the Canadian consensus on this subject matter. Both conclude--in line with the SC decision--that terminal illness should not be an access threshold criterion." Arguably indeed. Why should that kind of overlapping consensus simply override the only one in Canada reached after a vast public discussion and enacted as law? Surely this is a moral and political question worth discussing.

  With respect to conscientious objection, the author explains: "Doctors' lobby groups, such as the Canadian Medical Association and religious doctors' groups clearly overplayed their hand when they decided to take a hardline stance on the question of conscientious objection. They lobbied governments to be given the right to refuse to provide either assistance or transfer patients on to a professional who would provide the service." If that is true for doctors in the ROC, it is clearly false for doctors practicing in Quebec who have long been obliged to help the patient find another doctor in the event of conscientious objection. This obligation was reaffirmed in the Act Respecting End-of-Life Care. Besides, it is evident that conscientious objection is much less of a problem when a large part of the population, including doctors, has actively participated in creating the consensus, which has clearly been the case in Quebec. So, there are alternatives to simply taking away conscientious objection rights.

  With that information in mind, it is not so easy to conclude that Canada is on course to introduce a permissive assisted dying regime. Maybe this will happen in the long run, but, for now, the fact is that in June 2016 the Parliament of Canada finally voted, despite the recommendations of the advisors they appointed, for a MAID regime somewhat less limited than the Act Respecting End-of-Life Care but much more restrictive than the author anticipated.

  Michele Marchand, M.D., Ph.D.(Philosophy)

  Conflict of Interest:

  None declared

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  Conflict of Interest:
  None declared.

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