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LYSIANE GAGNON

Help to die? Careful what you ask for Add to ...

Quebec is at the forefront of the “right to die” movement. A law legalizing what is euphemistically called “medical help to die” will soon be adopted, since all the provincial political parties agree on the issue and there have been few dissident voices. At first glance, this looks like a surprising unanimity. But the reality is somewhat murkier.

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In a survey conducted in September for a group of physicians involved in palliative care, Ipsos Marketing found that the issue is fraught with huge misunderstandings and that the soft expression chosen by the government is misleading.

Only one-third of Quebeckers understand (correctly) that “medical help to die” means active euthanasia: a lethal injection performed by a physician on a patient who requested death. Another third of respondents confuse this procedure with palliative care. And 40 per cent confuse it with withdrawing the aggressive life-support techniques that can artificially prolong life. As for the rest of Canada, the survey shows that only 59 per cent can provide a correct definition of euthanasia. (In total, 2,078 Canadians were polled, including 1,010 in Quebec.)

Another source of confusion is the association of medically assisted suicide – this is what we’re really talking about here – with the concept of “dignity.” The report of the three-party committee that paved the way for the current bill was titled Mourir Dans La Dignité (Dying With Dignity), as if natural death was an undignified, vaguely shameful end of life.

Then there is the rather troubling fact that the first group to push for medically assisted suicide in the province was the Quebec Federation of Specialist Physicians, who called for legislation in 2009 on the basis of a survey held among its members. Among the 23 per cent of physicians who bothered to answer (a low response rate to begin with), a “majority” wanted active euthanasia to be framed by a law, if only to be protected from potential lawsuits. (Passive euthanasia, such as the injection of potentially lethal drugs to alleviate suffering, is performed relatively routinely in Canadian hospitals.)

Considering the scarcity of hospital facilities, one cannot avoid wondering whether some physicians aren’t motivated by the wish to get rid of these poor useless bodies awaiting death in costly beds, in order to make more space for other patients.

With the poignant testimony of severely ill Canadians who pleaded for the right to choose the time of their death, the issue has gathered steam. It’s fallen on a large receptive audience, the baby boomers, who are approaching old age.

The future law will allow a physician to administer, after consultation with another physician, a lethal injection to a patient who requests it, providing the patient suffers unbearable pain and is affected by an incurable disease for which all treatments have failed. This is actually the condition of the patients in palliative-care units, whose pain is controlled by morphine. Are they being sent a subtle message?

So far, the palliative-care specialists and the advocates for severely handicapped people have been among the few to raise objections to the future legislation. Those who presented a contradictory opinion at the parliamentary commission that studied the bill felt that their point of view was totally dismissed.

The next thing on the agenda, the province ombudsman said this week, will be to find a way to provide “end of life” care to people with dementia. We are on a slippery road.

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