Quebec to expand law on medically assisted dying, look at advance consent

The Quebec government wants to expand the criteria for accessing medical assistance in death in the province, the provincial health minister announced this morning. 

Report also recommends government expand the notion of 'end of life'

Quebec Health Minister Danielle McCann presented a report Friday on medical assistance in death, which recommended the law be expanded to allow advanced consent. (Radio-Canada)

The Quebec government wants to allow those diagnosed with diseases like Alzheimer's to provide advance consent for medical assistance in dying, the provincial health minister announced this morning. 

Danielle McCann presented the recommendations of a report tabled today, after a panel of experts spent 18 months examining the issue around a patient's ability to consent to the procedure.

"We heard the heartfelt cries of those who are suffering and have been asking for a broadening [of the law]," McCann said at the announcement, noting advance consent could provide Alzheimer's disease patients relief from years of suffering. 

McCann also announced the government will be holding public consultations as part of an effort including all four major parties to expand the criteria to access medical assistance in dying.

Quebec's law stipulates that a person seeking medical assistance in dying must be able to consent at the time of their request, as well as at the moment it is administered.

In the case of patients suffering from Alzheimer's, they may be able to consent after their diagnosis. But in order to receive medical assistance in dying in Quebec, a person also has to be at the "end of life."

The report commissioned by the provincial government recommends allowing people in those situations to make a request for a medically assisted death in advance, before they get to a point in their illness where they may no longer be able to consent to it. 

Quebec has 'moral duty' to respond, minister says

"Quebec society's [views are] evolving on this sensitive issue and we have the moral duty to respond to it," McCann said. 

In May, Montrealer Michel Cadotte was sentenced to two years less a day in jail for killing his wife, who was in the late stages of Alzheimer's after suffering from the disease for more than a decade. 

Michel Cadotte was convicted of manslaughter at the Montreal courthouse Feb. 23, 2019. (Paul Chiasson/The Canadian Press)

After Cadotte admitted to ending Jocelyne Lizotte's life in February 2017, the case sparked debates in Quebec about whether people should be allowed to provide advance consent. 

During Cadotte's trial, the jury heard that he had tried to obtain medical assistance in dying for his wife, but was refused because she could no longer consent to it and he could not provide it on her behalf. 

The court also heard from Lizotte's family that she had made comments about preferring to die rather than suffering from the disease. 

The report recommends enlisting a third party, such as a family member, who would inform health professionals of a patient's advance consent. That third party should not provide consent on the patient's behalf if advance consent doesn't exist, though, the report says.

All-party effort to expand law

Opposition critics from Quebec's three other major parties sat next to McCann at the news conference Friday morning, including Liberal André Fortin, Quebec Solidaire's Sol Zanetti and the Parti Québécois's Véronique Hivon. 

Hivon co-led the initial bipartisan project of drafting Quebec's law on medical assistance in dying with the Liberals a decade ago..

"I have the same feelings as I had 10 years ago, which is an enormous sense of responsibility," she said. 

Premier François Legault said the government is in favour of expanding the law and that he feels the population is, too. 

"Of course, we need to make sure there's proper consent and we need to make sure it's not because the [end-of-life] services they're receiving fall short," Legault said.

Another of the report's recommendations is to increase quality and access of the province's palliative care services. 

Some health care providers have decried a lack of care in some regions and said it was pushing people to choose medical aid in dying as a way to end their lives with dignity.

In September, a Quebec Superior Court justice declared parts of both the federal and provincial laws on medically assisted dying unconstitutional, saying their criteria for end of life is too restrictive. 

All four major parties in Quebec will participate in the effort to expand the province's medical assistance in dying law. The effort was announced Friday morning by provincial Health Minister Danielle McCann, second from left, Liberal health critic André Fortin, left, Québec Solidaire's Sol Zanetti, second from right, and the Parti Québécois's Véronique Hivon. (Radio-Canada)

The experts who wrote the report recommended the government re-evaluate the criteria that someone must be at the end of their life and consider expanding it to "the notion of being on an end-of-life journey."

But McCann noted the two issues — of consent and end of life — are separate and the latter was not part of the experts' mandate.

The government did not appeal the Superior Court decision and has until March 11, 2020 to come up with a solution. 

The Superior Court decision was in response to a court challenge by two Montrealers with degenerative diseases, Jean Truchon, 51, and Nicole Gladu, 74. 

Gladu and Truchon are among a number of Quebecers with degenerative diseases who have described years of intense suffering, but cannot obtain a medically-assisted death.

The lawyer who took up Gladu and Truchon's case, Jean-Pierre Ménard, said the report and public consultation are a step forward, but that based on the recommendations, the government appears to be taking a cautious approach that may make it difficult in practice to obtain advance consent. 

McCann said she wants to complete the consultation process by the end of the Coalition Avenir Québec government's mandate in 2022.

With files from Cathy Senay and Sarah Leavitt