The Quebec government promises to protect physicians from criminal prosecution should they choose to participate in a form of medically supervised euthanasia proposed in the 'end-of-life care' bill tabled Wednesday in the National Assembly.
Quebec has entered unchartered waters in becoming the first province to propose legislation that allows a dying patient with an incurable disease "at an advanced state of irreversible decline" and suffering "unbearable physical and psychological pain" to decide their moment of death.
Strict protocol and criteria are outlined in the bill that calls for continuous medical supervision of patients who must meet specific conditions in order to be eligible for end-of-life treatment. For instance, a paraplegic, despite suffering intolerable pain, would not be admissible.
Social Services Minister Véronique Hivon insisted that the bill was compatible with the federal Criminal Code because the proposed end-of-life treatment was part of a "continuum" of health care.
"I want to repeat that euthanasia, for example, is not provided for…is not forbidden in the Criminal Code. There are general provisions and there is something specific about assisted suicide but nothing on euthanasia," Ms. Hivon said, insisting the bill was a health measure that falls under provincial jurisdiction.
Euthanasia is the act of a doctor taking someone's life at their request, while, in assisted suicide, a doctor would provide the means of suicide that would be activated by the patient.
Ms. Hivon argued the bill was on solid legal footing. She said the government was considering giving an added legal protection to doctors by offering not to prosecute them, similar to the province's stand on abortions in the late 1970s.
"This has nothing to do with criminal matters and everything to do with medical care," Ms. Hivon said.
The minister added that while the issue has been debated in Quebec for the past few years, the federal government has shown no sign that it would oppose such a law.
Federal Justice Minister Rob Nicholson said in a statement Wednesday that the federal government will review the implications of Quebec's proposed legislation and that euthanasia and assisted suicide are currently illegal.
The bill focuses on improving palliative care which would require all hospitals to offer proper care for terminally ill patients including palliative sedation, which is widely used in hospitals. More than $15-million has recently been granted to hospitals to improve palliative care services.
Under the new rules, terminal palliative sedation, that places patients in a state of unconsciousness and where they are deprived of food and water, would require consent beforehand in writing and filed in the patient's record. Death often occurs within days but can sometimes take longer.
The end-of-life treatment proposed in the bill would provoke a much quicker death. The so-called medical aid to dying would involve the injection of a yet to be determined drug, administered by a physician after terminally ill patients who met all the strict criteria had freely complied with the procedure.
"It is not an additional dose of morphine. That is not what it is. It is a medication that is more precise. And I can't tell you what it is exactly," Ms. Hivon said adding that the College of Physicians and the Order of Pharmacists of Quebec were working on the protocol.
Only Quebec residents would be eligible for the end-of-life treatment. Based on statistics in Europe and the United States, where euthanasia or assisted suicide is practised, the Quebec government estimated that end-of-life procedures would be requested in fewer than 1 per cent of total deaths.
Physicians will be allowed to refuse for moral reasons to administer end-of-life treatment. And the minister also insisted that Quebec was not embarking on a slippery slope that pave the way for abuse. Quebec will soon not be alone in proceeding on this contentious issue, she predicted.
"I know many other provinces are looking at what Quebec is doing right now….because all that we are doing is dealing with a health matter," she said.
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 popular 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, Dr. Paul Saba, who practises at St-Joseph Hospital in Lachine near Montreal. "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 improved palliative care would be 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.