On June 5, 2014, CBC News reported that Bill 52, also known as “an act respecting end-of-life care” was passed in the Quebec National Assembly. The bill passed with 94 in favour, 22 opposed and no abstentions.
Bill 52 was drafted further to a comprehensive National Assembly committee report, “Dying With Dignity” which was released in March 2012. The legislation is referred to as the “dying with dignity” law. While the bill deals with the right of terminally ill patients under limited circumstances to request medical assistance with ending their lives, it also sets out in-depth requirements for health care facilities and professionals and government bodies to deal with individuals and their care at the end of their lives.
The purpose of the Act is set out as follows:
The purpose of this Act is to ensure that end-of-life patients are provided care that is respectful of their dignity and autonomy and to recognize the primacy of wishes expressed freely and clearly with respect to end-of-life care. The Act establishes the rights of such patients as well as the organization of and a framework for end-of-life care so that everyone may have access, throughout the continuum of care, to quality care that is appropriate to their needs, including prevention and relief of suffering.
In addition, the Act recognizes the primacy of freely and clearly expressed wishes with respect to care, in particular by establishing an advance medical directives regime.
The bill provides that all individuals who require end-of-life care are to be provided with that care, and requires all health care institutions to offer end-of-life care.
On the issue of “medical aid in dying”, section 26 of the bill strictly circumscribes the circumstances under which a patient may obtain such assistance. The patient must be of full age, and capable of consenting to care, and must “be at the end of life; suffer from a serious and incurable illness; be in an advanced state of irreversible decline in capability; and experience constant and unbearable physical or psychological suffering which cannot be relieved in a manner the patient deems tolerable.” It also requires that the patient him or herself makes the request “in a free and informed manner” and in the presence of a health or social services professional. The physician attending to the patient must ensure that all of the legislative criteria are met, that the request is made freely and is an informed choice by providing information on the patient’s prognosis and all treatment options. The doctor is also required to speak with the patient on several occasions, as well as the care team, and with family members if the patient wishes. The physician is required to obtain a second opinion by an independent physician, who must consult the patient’s chart, examine the patient and provide the opinion in writing.
The bill also deals with advance medical directives, and provides that a person who is of full age, and is capable of consenting to care may set out their wishes in the event they are no longer capable of consenting to treatment, by way of advance medical directive. The bill clearly provides that a person may not request medical aid in dying in an advance medical directive.
Interestingly, the bill also provides that the Minister of Health and Social Services is to establish and maintain an “advance medical directives register.”
The bill also establishes a commission on end-of-life care to provide ongoing feedback and evaluation to the Minister of Health on the legislation and any matter relating to end of life care.
While much of the media attention is focused on the issue of “medical aid in dying”, the legislation itself aims to set out a comprehensive regime to assist individuals who find themselves at the end of their lives (whether they choose to deliberately terminate their lives or not) and to ensure that there are adequate supports and compassionate care provided for those patients.