Quebec continues to allow advanced requests for assisted death

Quebec is moving ahead with its plan to approve early requests for medical assistance in dying, despite concerns from the federal government.

Starting Oct. 30, the province will begin accepting requests for assisted dying, known as MAID, before a person’s condition, such as Alzheimer’s disease, makes him or her incapable of giving consent.

Health officials held a briefing for journalists early Thursday to outline how applications will be considered, and pointed out new online guidelines for patients and doctors.

Dr. Stéphane Bergeron, an assistant deputy health minister, said at the briefing that patients who might qualify would have to meet with doctors multiple times to understand how it would work and when it would apply.

“It’s going to take some time for this to go through,” Bergeron said.

Ottawa says to ‘wait’

The federal government has repeatedly expressed concern that Quebec is moving ahead with prior approval before amending the Criminal Code.

Federal Minister of Health Mark Holland told La Presse Wednesday that Quebec should “wait” before moving forward.

In a follow-up statement to CBC News, his office said Thursday that the federal government is “taking the necessary time to investigate the details of what the Quebec government has announced.”

“We are committed to working with Quebec – and all provinces and territories – to carefully consider the next steps,” the statement said.

On Thursday, Sonia Bélanger, the minister responsible for seniors, said the province has made a “rigorous” assessment of how the new rules will be applied and will move forward without Ottawa.

“In the case of MAID, we never waited for the federal government,” she told reporters in Quebec City.

For more than a year, Quebec has been calling on the federal government to change the Criminal Code to allow people to make such requests — and made it clear in August it would wait no longer.

The provincial government passed a law in June 2023 that allows people with serious and incurable diseases, such as Alzheimer’s disease, to apply for assisted death while having the opportunity to consent, with the procedure carried out after their condition has deteriorated.

The province has asked the director of criminal and criminal prosecutions to respect the conditions set out in the law regarding end-of-life care when it comes to filing criminal charges.

A matter of dignity

Georges L’Espérance, a retired neurosurgeon and head of the Quebec Association for the Right to Die with Dignity, does not believe it is necessary to wait any longer.

“We have a lot of reports on that, and we have a lot of expertise on that,” he said.

L’Espérance said it is up to patients and their families to determine at what stage they no longer want to live, and that can vary from person to person. For example, a person with Alzheimer’s disease may decide he wants MAID if he no longer recognizes his family or can’t feed himself, he said.

“If you have that law, you know that in the last year of the disease you will not go down a path where you lose all your dignity,” he said.

Some health professionals remain opposed to the changes. Dr. Catherine Ferrier, assistant professor at McGill University’s department of family medicine and a member of the group Living with dignityhas been working with patients with dementia for 40 years.

She said it will be difficult for a patient to know whether they want to die in five years or more.

“There are a lot of unknowns there,” she said. “You don’t know if you will suffer.”

Ferrier said the province should instead focus on providing better care to patients with dementia.

“You are never unworthy. You have the dignity of a person for your entire life,” she said.

“I think it’s sad that in Quebec we’re not providing all the support that people need as they get older and more vulnerable and people lose their cognition, and then we’re accelerating death.”