A new Quebec law that mandates palliative care facilities to provide medical assistance in dying has drawn criticism from euthanasia opponents and a palliative care advocate.
Bill 11 to expand medical assistance in dying (MAiD) passed in Quebec’s national assembly on June 7.
In a June 5 post online, Living with Dignity (Vivre Dans La Dignité), a non-profit opposed to euthanasia and assisted suicide, decried the bill’s “profoundly unfair treatment of palliative care hospices, particularly those not wishing to offer MAiD.”
The organization said it was even more “deeply disturbed” by a late amendment to the bill. Sonia Belanger, minister for health and seniors, added the provision that a hospice “cannot refuse to receive a person for the sole reason that the latter has submitted a request for medical assistance in dying” and created a deadline of six months for palliative care homes to comply.
Although only four palliative care hospices are known to not wish to offer MAiD, the government approach to admission criteria was opposed by the Alliance of Palliative Care Homes of Quebec during public consultations.
The bill received near-unanimous support in a free vote, with 103 members in favour, two opposed, and one abstention. Dr. Catherine Ferrier, a board member for Living with Dignity, regretted that so little opposition could be found.
“It is of course very bad news that the law passed with such a big majority of votes. Politicians in Quebec seem to think that expansion of euthanasia is inevitable and that their role is to make it safe. It’s seen as an act of compassion,” Ferrier told The Epoch Times via email.
“But it is never safe and is an act of abandonment of the patient.”
Alex Schadenberg, founder of the Euthanasia Prevention Coalition, said patients had access to MAiD before the law, and the change only forces palliative care homes to become active participants.
“It’s a serious issue for conscience rights because now every palliative care institution is going to have to offer this," Schadenberg said in an interview.
“There were a couple of palliative care institutions that were created more recently, meaning after the legalization of euthanasia they were created specifically because they wouldn’t offer it and they were trying to provide what we would call a safe space.”
The law imitates a mandate given to palliative care homes in B.C. in 2017. The policy was resisted by the Delta Hospice Society (DHS), but the province eventually took over the private care home arbitrarily. In an interview, DHS president Angelina Ireland said the values and practice of euthanasia and palliative care are opposed.
“Palliative care is a 50-year medical discipline that is very clear about what it entails, and it never includes MAiD and never includes euthanasia, and the father of palliative care, Dr. Balfour Mount, is from McGill University. So it’s very ironic in this moment that Quebec is moving in that direction,” Ireland said.
“This political movement is forcing a coercive makeover of what palliative care is. They'll scream up and down that it’s about human rights, but it looks more like a cull to me because we’ve opened up Pandora’s Box. And when they just promised it’s only a little bit of MAiD, it’s turned out to be something that every vulnerable Canadian has to be afraid of.”
Ireland said the precedent in B.C. suggests that those morally opposed to the imposition of euthanasia will exit the profession, but the palliative care facilities will remain.
“There have been doctors who’ve walked away from palliative care medicine, doctors and nurses who have just left their careers, because they don’t want to have anything to do with it. But the administrators just jumped on board. And, because [the DHS] refused to, they literally took everything from us.”
McGill University professor of ethics and theology Douglas Farrow decried Bill 11 in a recent Substack post. The law, he said, “reeks of the death-fetish into which we too have fallen,” just as the German government did in World War II.
“What better way to erode the distinction between care and killing, indeed to erase it altogether, than to insist that the one is not permitted without the other?” Farrow wrote.
“We will no longer have any ethical conflict over state-sponsored dying, because in the places where death regularly occurs we will have no ethics at all.”
Other Provisions
The legislation withdraws the end-of-life criterion for MAiD and allows persons suffering from a serious and incurable illness leading to incapacity to make an advance request for the procedure. However, it does specify that a mental disorder is not an illness.It also extends the right to die to people who have a “severe physical impairment resulting in a significant and persistent disability.”
Bill 11 facilitates specialized nurse practitioners to administer continuous palliative sedation and medical aid in dying, The bill also allows nurses to establish that a death has occurred and fill out a death certificate.
Dr. Francis Evoy testified to a parliamentary commission on April 20 that cases of “happy dementia” might still be hiding psychological suffering, an interpretation euthanasia opponents wanted to prevent.
“There is no acceptable framework for the clinical manifestations for receiving MAiD by advance directive. Many issues, including the sedation of individuals with diminished capacity prior to administering MAiD…have been postponed until the practical guide (to implementing the new legislation) is drafted,” Living with Dignity stated.
“We must promote medical assistance in living!”
Pier Luc Turcotte, an occupational therapist, University of Ottawa assistant professor, and a member of an expert panel examining Bill 11, also warned of the negative consequences in an article published in Le Devoir.
“The expansion of medical assistance in dying for people with physical disabilities opens the door to major abuses, with very few solid guidelines to prevent them,” he wrote.
After the bill was tabled on Feb. 16, Turcotte said his expert group met 11 times in five weeks in “a hasty debate.” Three days before the final report was filed May 16, a dozen groups for the defence of the rights of persons with disabilities arrived to talk to the forum, but none of their concerns or recommendations were incorporated into their report to legislators.
Minister Belanger made another amendment to the bill due to media reports of funeral homes renting out rooms to provide MAiD. The amendment expands the locations where MAiD can be provided, but bars the promotion and marketing of MAiD.
The bill ensures owners and managers of inns, campgrounds, cottages, and parks who refused to allow MAiD on their property maintain their conscience rights. However, Living with Dignity said expanding MAiD locations “trivializes death“ and those who refuse to allow it could face “odious consequences.”
In February, Quebec’s Commission on End-of-Life Care reported the province would have 7 percent of all deaths come from MAiD when the annual tally for the fiscal year was completed. Schadenberg expects expanded access will only increase the total.
“Why are they so into killing now?” he asks.
“They’ve expanded the law even though they have the most number of euthanasia deaths in the world, percentage-wise. So when you start putting this into perspective, this is a very concerning situation.”
