Quebec is being asked to take the bold step of legislating a form of medically supervised euthanasia.
A report entitled Dying With Dignity that an all-party select committee tabled on Tuesday, includes a proposal called "medical aid to die" that is based on the opinion that dying is a part of life, and since medical assistance is used to prolong life, it should also be used in extreme cases to end it.
"Medical aid to die is more of an evolution than a revolution," said Parti Québécois MNA Véronique Hivon, the committee co-chair. "The patient must be the one who asks the assistance. It cannot be in any case someone else who asks for it."
After more than two years of sometimes difficult deliberations and public hearings, the committee proposed that the government legislate an end to the enforcement of long and painful deaths.
The committee insisted the proposal is in no way a form of assisted suicide but rather the ultimate health care solution for the terminally ill.
"This approach abandons the debate over the legalization of euthanasia to situate it in terms of appropriate end-of-life care," Ms. Hivon said.
Quebec Health and Social Services Minister Yves Bolduc has yet to respond to the recommendations.
Euthanasia is illegal under the federal criminal code, and the committee proposes provincial legislation to protect doctors from criminal prosecution if the government approves the recommendations.
Ms. Hivon explained that the provinces have jurisdiction over the administration of justice. She said that after several juries in the 1970s acquitted doctors who performed abortions, the province stopped prosecuting them, and Quebec could adopt a similar policy for the proposed form of euthanasia.
The practice would have to be strictly defined, the committee stated in its report. For instance, minors would be prohibited from making such a request, and only an enlightened and well-informed person would be allowed to request medical assistance to die. The person would also have to have a serious and incurable disease with no hope of improvement.
The committee proposes that the process be rigorously monitored. A patient requesting medical assistance to die would submit a signed form that would be reviewed periodically with the assistance of the patient's doctor, who must also sign the form and obtain a second opinion from an independent physician.
The committee argued that such a practice would be much more humane than the one widely used in many hospitals, where palliative units sedate patients into unconscious until they die.
Former doctor Marcel Boivert, who practised medicine at Montreal's Royal Victoria hospital, testified before the committee that, in their efforts to alleviate pain, doctors in fact precipitate death.
"In reality, when terminal sedation has begun, no doctor wants to unduly prolong it, which amounts to hoping that it will be short and therefore hoping for death," Mr. Boisvert told the committee.
Committee member Amir Khadir of Quebec Solidaire, who is also a physician, said that the proposal for medical aid to die amounts to clearly defining a practice that is currently being used without proper supervision.
"With this recommendation, we are going to put into place a consistent and coherent framework," Mr. Khadir said. "Sometimes, the best cure, the best health care they can give is to help the patient die."
Several recommendations also call for major improvements to palliative care, including facilities.
"There is unanimous support that palliative care is by far the best response to the suffering of a majority of dying patients. But it has to be improved," said Liberal MNA Maryse Gaudreault, committee co-chair.
The committee said a poll it took showed that most Quebeckers – up to 74 per cent of 6,600 residents surveyed – support some form of medically assisted euthanasia.