The same province that historically pushed the envelope in liberalizing abortion and same-sex marriage has tabled legislation that, if passed, will legalize euthanasia for the first time in Canada and offer the most radical end-of-life options of any jurisdiction in North America.
The government of Premier Pauline Marois's government tabled an act on end-of-life care in the Quebec National Assembly on Wednesday, after nearly five years of debate and consultation.
The bill, which appears to have bipartisan support, attempts to detour around the federal Criminal Code prohibition against aiding a suicide by focusing exclusively on health care and the administration of justice, which are provincial responsibilities.
In the 20 years since Sue Rodriguez, a British Columbia woman afflicted with ALS, lost her legal challenge to have a medically assisted death, several jurisdictions in North America and Europe have provided end-of-life care for terminally ill patients. As the population ages, the number of terminally ill people seeking help in ending lives that have become intolerable has grown from the voice of one lone woman to a chorus.
David Lambert, a retired orthopedic surgeon in Sherbrooke, says the right to die is about increasing compassion for patients at the end of life. At 74, he has been diagnosed with metastasized prostate cancer.
"Many people aren't afraid of dying," he said. "It is the process of dying that scares them."
As a doctor, he has the "resources to bring about a gentle end to my days at a time of my choosing," so he doesn't "have to worry about suffering an agonizing death." He wants other people to have the same opportunity.
Unlike Oregon, Washington and Vermont, the Quebec legislation is not limited to assisted suicide in which a terminally ill patient, who is mentally competent, ingests a lethal potion prescribed by a doctor, says Jocelyn Downie, a law professor in the medical and legal faculties at Dalhousie University. The bill, which refers to "terminal palliative sedation" and "medical aid in dying," doesn't mention the word euthanasia, but that is the intent, Prof. Downie says. "Absolutely, it allows for euthanasia. That is what this is for," she said, drawing a comparison to Belgium which twins extensive palliative care with the possibility of euthanasia.
As with abortion, doctors will be allowed to refuse to provide end-of-life service on grounds of conscience.
The National Assembly will rise for its summer recess at the end of the week, which will allow plenty of time for opposition to brew, especially in Ottawa. The federal government is already challenging the 2012 British Columbia Supreme Court ruling that the Criminal Code provision against assisted suicide is unconstitutional, so it is likely that the Quebec legislation will face similar legal hurdles.
Ottawa could argue it is not within the mandate of the province to make these rules and regulations, says Udo Schuklenk, a professor of bioethics at Queen's University and chair of the 2011 Royal Society of Canada panel that investigated end-of-life issues. The panel recommended that assisted dying should either be decriminalized by the Supreme Court of Canada, or that the provinces could act in the absence of a legal ruling by refusing to prosecute doctors who assisted patients to die. "As far as I can see," Prof. Schuklenk said, "this is the direction they are taking in Quebec by redefining assisted dying to be part of continuing medical care, which is also the way we interpreted the situation."
Will people be travelling across the country, turning Quebec into a "death tourism" destination as critics label Switzerland, which allows non-residents to die by medically assisted suicide? The bill restricts services to Quebec residents who are covered under the provincial health insurance plan. Some people may move to Quebec, in the same way that some terminally ill patients fly to Zurich, but the three-month residency requirement will prevent wide-scale abuse, says Prof. Downie. "People can't move for physical, financial, emotional and social reasons," she said. "You have to be well enough to travel and you are picking up and moving out of your community of support."
Liberal leader Philippe Couillard said he was considering allowing his caucus to vote freely on the issue. Public hearings will be heard in the fall and the opposition parties want to closely examine the legislation before determining final judgment. There was already an all-party consensus on the principle of allowing for end-of-life treatment.
Public opinion polls have indicated widespread support for the types of measures proposed in the bill. However, several groups are expected to mount a strong opposition.
The Coalition of Physicians for Social Justice said the bill does nothing less than open the door to abuse and homicides. "This is not care. It is killing patients because they don't get the proper care they should," said the group's spokesperson, Paul Saba, who practices at St-Joseph Hospital in Lachine. "We are giving a free hand to end the life of people. There will be abuse. This is immoral and unconscionable … life is too precious."
Dr. Saba said the bill was not needed, arguing that enhanced palliative care would vastly improve the conditions of terminally ill patients. He argued that 80 per cent of Quebeckers do not have access to palliative care largely because of government cutbacks in health-care services.